Ep 229 - Top Twenty Papers of 2023 - Part 1 - Airway
Apr 17, 2024
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In this podcast, they discuss important topics such as optimal intubation practices in trauma cases, the impact of laryngoscope blade size on intubation success, using small adult ventilation bags in cardiac arrest cases, evaluating non-invasive airway management for comatose poisoned patients, and managing complex patient care in the emergency room.
Intubating bleeding trauma patients in the operating room instead of the emergency department reduces mortality by 20%, highlighting the importance of location choice for intubation.
Video laryngoscopy (VL) for tracheal intubation in critical adults leads to an 85.1% first-pass success rate, proving its effectiveness over direct laryngoscopy (DL).
Deep dives
Intubation Location Impact on Mortality
Intubating bleeding trauma patients in the operating room instead of the emergency department showed a 20% decrease in mortality. Intubating in the ED led to longer stays, more transfusions, and increased complications, even after adjusting for factors. The decision to intubate in the ED was more influenced by department culture rather than patient need, showing an associated higher mortality risk.
Video Laryngoscopy First for Intubation
A randomized trial concluded that using video laryngoscopy (VL) for tracheal intubation in critical adults resulted in an 85.1% first-pass success rate, compared to 70.8% with direct laryngoscopy (DL). The study suggested that VL is more effective, especially for less experienced intubators, showcasing significant success rate differences.
Blade Size Influence on Intubation Success
Observational data on tracheal intubation blade sizes in critical care patients indicated a higher first-pass success rate with a size three blade over a size four. The study highlighted that the standard blade size aligns better with a size three for most patients, challenging the widespread use of size four blades intimating for smaller adults.
Airway Management in Cardiac Arrest and Poisoning
Using smaller ventilation bags for cardiac arrest showed a lower return of spontaneous circulation rate, suggesting a potential drawback in avoiding hyperventilation. For patients with acute poisoning, a watch-and-wait policy may be safe, avoiding unnecessary intubations. Mild hypercapnia showed no difference in outcomes post cardiac arrest, emphasizing the need for careful airway management decisions in critical situations.
In this two part podcast special Iain and Simon go through twenty of the top papers from the last year or so, as presented by Simon at the Big Sick Conference in Zermatt earlier this year. All the details and more discussion can be found on the blog site.
In Part 1 they discuss all things airway, including where we should be intubating patients needing immediate haemorrhage control. VL vs DL, the effect of blade size on intubation success, whether small adult ventilation bags are better than larger versions, intubating comatose poisoned patients, and more.
Check out part 2 for papers about major haemorrhage, trauma, cardiac arrest and more.