Articles: intubation.
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Am. J. Respir. Crit. Care Med. · Feb 2025
Randomized Controlled Trial Multicenter StudyHumidified Noninvasive Ventilation versus High-Flow Therapy to Prevent Reintubation in Patients with Obesity: A Randomized Clinical Trial.
Rationale: The optimal strategy to prevent reintubation in patients with obesity remains uncertain. Objectives: We aimed to determine whether noninvasive ventilation (NIV) with active humidification is superior to a high-flow nasal cannula (HFNC) in preventing reintubation in patients with obesity at intermediate risk. Methods: We conducted a randomized controlled trial in two ICUs in Spain (June 2020-June 2021). ⋯ Conclusions: Among adult critically ill patients with obesity at intermediate risk for extubation failure, the rate of reintubation was not significantly lower with NIV than with HFNC. Nevertheless, there is a risk for underpowered results. Clinical trial registered with www.clinicaltrials.gov (NCT04125342).
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Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation. ⋯ Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.
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Randomized Controlled Trial Comparative Study
Comparing first pass success of Channeled versus Non-channeled KingVision video laryngoscopes in patients presenting to the emergency department - A randomized control study.
In modern times, the emergency physician (EP) has access to a host of video laryngoscopes (VL). There are different makes, models, angulations in the blades provided by different VLs. The blades may be channeled or non-channeled. In busy emergency departments (ED), ease and speed of intubations in managing the emergent airways may impact the outcome for the patient. ⋯ We found the non-channeled blades to have a significantly higher percentage of first pass success. Performance with respect to time to intubate was similar between the two. We recommend using the non-channeled KVVL for intubations in the EDs.
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Journal of anesthesia · Feb 2025
Effect of use of cuffed endotracheal tubes on the occurrence of postoperative extubation-related respiratory adverse events in pediatric patients with airway hypersensitivity: a retrospective cohort study.
Whether endotracheal tube (ETT) configuration (cuffed or uncuffed) influences the occurrence of respiratory adverse events (RAEs) in patients at risk remains largely unknown. We investigated the effects of cuffed ETTs on RAE occurrence after extubation in pediatric patients with airway hypersensitivity. ⋯ In pediatric patients with airway hypersensitivity, the use of cuffed ETTs did not increase the occurrence of RAEs or respiratory interventions after extubation.