The Resus Room July 2024; papers of the month
10 snips
Jul 1, 2024 This podcast discusses the groundbreaking PREOXI trial comparing pre-oxygenation methods in critically unwell patients. They also explore the use of lidocaine patches for rib fractures and the benefits of CT head scans for patients with a first seizure. Additionally, the hosts banter about creating a podcast-inspired sticker album and humorously discuss trading stickers in hospitals during the Euros football matches.
AI Snips
Chapters
Transcript
Episode notes
NIV Cuts Hypoxia In Emergency Intubation
- The PRE-OXY trial found NIV pre-oxygenation halved hypoxia rates compared with oxygen face mask (9.1% vs 18.5%).
- This suggests NIV can substantially reduce desaturation during emergency intubation in critically ill adults.
Follow The Trial's NIV Settings
- Use tight-fitting NIV with FiO2 100%, IPAP ≥10 cmH2O, EPAP ≥5 cmH2O and respiratory rate ≥10 during pre-oxygenation when feasible.
- Apply for at least three minutes prior to induction and continue until laryngoscopy to match trial protocol.
Consider Depth Vs Duration Of Desaturation
- A single brief desaturation below 85% was the trial's primary outcome but duration of hypoxia varied and carries different clinical weight.
- The ED subgroup CI crossed significance, so differences may be context-dependent.