ACEP Frontline - Emergency Medicine The Crashing ED Airway Tips and Tools with Drs. Bruce Lo and Deb Diercks
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Dec 8, 2025 Dr. Deborah Dirks, an expert in airway management at UT Southwestern, and Dr. Bruce Lowe, a seasoned emergency physician at Sentara Norfolk, dive deep into evolving airway tools in the ED. They explore the RENOVATE trial's findings on high-flow nasal cannula versus noninvasive ventilation. The discussion reveals insights on patient comfort, practical implementation, and the benefits of high-flow options, including reducing ICU admissions. Listeners will gain valuable tips to enhance their airway management strategies.
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RENOVATE Trial Clarified
- RENOVATE is a non-inferiority trial comparing high-flow nasal cannula to non-invasive ventilation across multiple settings.
- Non-inferiority means HFNC was shown to be no worse than NIV, not superior, in eligible populations.
Avoid HFNC In Immunocompromised Hypoxia
- Exclude immunocompromised hypoxic patients from HFNC based on RENOVATE's halted arm.
- Use HFNC as a comfortable first-line option for COPD, pulmonary edema, and non-immunocompromised ARDS when appropriate.
Follow RR And SpO2 To Guide HFNC
- Follow respiratory rate and SpO2 to assess HFNC effectiveness and escalate settings accordingly.
- Use the RENOVATE supplement's stepwise escalation/de-escalation to optimize flow and FiO2.