Articles: intubation.
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Emergency airway management outside the operating room (OR) is a higher risk procedure as compared to the OR setting. Inappropriate airway management leading to complications, including pulmonary aspiration, dental trauma, esophageal intubation, prolonged recovery, unplanned intensive care unit admission and death. The emergency difficult airway management team of Siriraj hospital has been established since 2018 under the name of Code-D delta. ⋯ This study showed the rate of Code-D delta activation, the emergency airway management code, was 8.14% with the success rate of 85% at scene. Emergency airway management outside the operating room is particularly challenging. Airway assessment, planning, decision making of the team relevant to the patients outcomes.
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Whether intubation should be initiated early in the clinical course of critically ill patients remains a matter of debate. Results from prior observational studies are difficult to interpret because of avoidable flaws including immortal time bias, inappropriate eligibility criteria, and unrealistic treatment strategies. ⋯ When realistic treatment strategies and eligibility criteria are used, strategies that delay intubation result in similar 30-day mortality risks compared with those that intubate early. Delaying intubation ultimately avoids intubation in most patients.
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Journal of critical care · Oct 2023
Meta AnalysisEtomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials.
We performed a meta-analysis of randomized controlled trials to evaluate if etomidate impacted mortality in critically ill adults when compared with other induction agents. ⋯ This meta-analysis found a high probability that etomidate increases mortality when used as an induction agent in critically ill patients with a number needed to harm of 31.