Pharmacists Christine Groth, Angela Slampak-Cindric, and Kevin Kaucher discuss RSI guidelines, pharmacotherapy, non-pharmacologic recommendations, and potential research ideas. They delve into the importance of evidence-based practices, medication safety concerns, and the impact of guidelines on clinical practice.
Pre-oxygenation with high flow nasal cannula is recommended before RSI for challenging laryngoscopy.
The semi-Fowler position is advised for critically ill adults during RSI to improve intubation conditions.
NG tube insertion is suggested for patients at high aspiration risk during RSI, pending further research.
Deep dives
Semi-Fowler Position During RSI
The guideline suggests using the semi-Fowler position for critically ill adults undergoing RSI based on potential benefits such as increased functional residual capacity and improved laryngeal view. Despite a conditional recommendation due to low-quality evidence, the position is feasible, low-cost, and supported by non-critically ill patient studies.
Pre-Oxygenation Methods in RSI
Pre-oxygenation with high flow nasal cannula is suggested for challenging laryngoscopy during a planned RSI. The guideline recommends this method to help prevent desaturation in patients during intubation, emphasizing the need for safe apnea time. Despite its conditional recommendation, the high flow method is considered a reasonable and cost-effective intervention.
NG Tube Decompression Before Intubation
In patients at high risk of aspiration during RSI, the guideline includes a best practice statement advising NG tube insertion for decompression if able. However, due to the lack of comparative studies and dated evidence, the quality of evidence remains ungraded. Future research is needed to explore the efficacy of NG tube intervention in preventing aspiration complications.
Exclusion of Older Studies in Guidelines
The guideline focuses on evidence from the past 20 years to align with current medical practices and standards. While some practices dating back to the 70s, like NG tube decompression, were considered as best practices, the guideline prioritizes recent research to provide up-to-date recommendations and support evolving medical practices.
Importance of Documentation Accuracy in RSI
Ensuring precise documentation during rapid sequence intubation (RSI) is crucial for capturing vital details like medication administration times and dosages. The podcast highlighted the speaker's experience of the demands for accurate documentation during an RSI event, emphasizing the challenges faced in recording real-time information meticulously. Electronic healthcare records offer tools like order sets and narratives to aid in swift and precise data capture. The goal is to maintain detailed records for future reference and improve patient care outcomes.
Impact of Guidelines on Clinical Practice
The podcast discussed the tangible impact of guidelines on clinical practice, as evidenced by a story shared about a pharmacist in Jordan altering practice based on guideline recommendations. The guidelines provided evidence-based support for using alternative medications, influencing positive changes in pharmacological practices. This exemplifies how guidelines serve as valuable resources for clinicians, facilitating informed decision-making when faced with medication choices, even in regions with limited availability of certain drugs.
