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Sinaiem dark
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respiratory-failure

As we all know, NiPPV is a well established practice and therapy of choice in patients with COPD and CHF exacerbations.  It is typically used in patients with hypercarbic respiratory failure.  But for those patients who come to the ED with pure hypoxemic respiratory failure (in say, someone with pneumonia) is there a better way to oxygenate them when standard nasal cannula isn’t doing the trick and you want to avoid intubation?  According to 2 recent studies high flow nasal cannula may provide the answer.  In comparing NiPPV to standard oxygen delivery therapy to high flow nasal cannula the intubation rates did not differ significantly, but appear to be lower in the high flow NC group.  Additionally, the 90 day mortality rate was significantly lower and ventilator free days were increased in the the high flow NC group compared to the other two.  The other benefit is that there was less patient discomfort in the high flow NC group.  
sinaiem.org
almost 7 years ago
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NYC Airway course , 19-20th September 2015 – PLACES STILL LEFT, HURRY!

Register for one of the last 10 spots remaining on this excellent airway training course Directed by Dr Richard Levitan, an awesome faculty will teach you the cutting edge of emergency airway management Learn from the likes of Scott Weingart and George Kovacs! Brilliant talk from @emcrit: consider DSI to prevent peri-intubation arrest in hypoxic…  
prehospitalmed.com
almost 7 years ago
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Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials

Interesting open access article from Switzerland! Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials  
prehospitalmed.com
almost 7 years ago
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28

Critical Care

Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient’s spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.  
ccforum.com
almost 7 years ago
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Apneic ventilation using pressure-limited ventilation

Introduction 0 Noninvasive ventilation (i.e. BiPAP) is arguably the most powerful approach to optimize oxygenation and ventilation before intubation, given  
pulmcrit.org
about 7 years ago
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Don’t just pre-oxygenate: have an Oxygenation Strategy |

A key component in the planning of intubation is pre-oxygenation. Recently apnoeic oxygenation during laryngoscopy has been adopted too. These are just two components of an overall oxygenation strategy to consider when intubating the critically ill. Some patients will require proactive preparation of the components of successful post-intubation oxygenation, especially those with severe lung pathology like ARDS.  
resus.me
about 7 years ago
Sinaiem dark
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a-tale-of-two-trachs

34 year old male with PMHx quadriplegia 2/2 GSW 8 years prior, with elective tracheostomy after his early disease course was complicated by frequent intubations for sepsis, presents to ED from NH with fever x1 day.  
sinaiem.org
about 7 years ago