1,217 results match your criteria: "Tracheal Intubation Rapid Sequence Intubation"

Introduction Tracheal intubation is a high-risk airway management protocol frequently applied in patients with critical illnesses. Numerous parameters have been suggested to predict mortality in these patients. Blood gas analysis, electrolyte levels, enzyme activities, and other biochemical measurements provide insights into a patient's metabolic status and organ functions.

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  • High-flow nasal oxygenation improves oxygenation during anaesthesia induction for pregnant women with obesity, but its effects compared to standard facemask ventilation were studied due to a lack of existing data.
  • A clinical trial involving 54 participants revealed that those using high-flow nasal oxygen had significantly higher oxygen levels after pre-oxygenation compared to the facemask group.
  • While high-flow nasal oxygen showed improved oxygenation results, the differences weren’t deemed clinically significant, suggesting it could be a viable option for these patients.
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  • Anaesthesia primarily depresses the central nervous system, impacting various physiological systems during procedures like hysteroscopy and endometrial ablation.
  • In this case study, preoxygenation helped maintain oxygen levels during apnoea, but Propofol significantly lowered the patient's respiratory rate, leading to apnoea.
  • The cardiovascular effects included a spike in heart rate from sympathetic stimulation during intubation and hypotension from anaesthesia induction, which was managed with ephedrine and required adjusted dosages of rocuronium and sugammadex for muscle paralysis reversal.
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Selective Use of Positive-Pressure Ventilation for Preoxygenation During Air Medical Rapid Sequence Intubation.

J Emerg Med

December 2024

Logan Health, Division of EMS, Kalispell, Montana; Air Methods Corporation, Greenwood Village, Colorado. Electronic address:

Background: Preoxygenation is critical to safe performance of rapid sequence intubation (RSI). The use of positive-pressure ventilation (PPV) has been advocated during preoxygenation but may increase the risk of aspiration.

Objective: To explore the risk-benefit analysis of using PPV during air medical RSI.

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The impact of ketamine on emergency rapid sequence intubation: a systematic review and meta-analysis.

BMC Emerg Med

September 2024

Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China.

Article Synopsis
  • Rapid sequence intubation (RSI) is essential in treating critically ill patients, and the choice of sedatives like ketamine can affect their outcomes, though past research shows mixed results on ketamine's effect on mortality.
  • A systematic review and meta-analysis were conducted involving 15 selected studies that included over 16,000 participants to assess ketamine's role in RSI.
  • Findings indicated that ketamine did not significantly affect in-hospital mortality rates compared to other sedatives, though low-quality evidence suggested it might reduce early mortality and improve ICU-free days.
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  • - **Endotracheal intubation (ETI) is crucial for critically ill patients**, but it has risks like hypoxemia; preoxygenation is used to enhance safety but can have unreliable monitoring through standard pulse oximeters (SpO2).
  • - **The Oxygen Reserve Index (ORI)** is proposed as a more reliable continuous measure during preoxygenation, targeting an ORI value of at least 0.6 over one minute instead of the standard SpO2 100% goal to improve outcomes.
  • - **A trial with 950 critically ill adults** will compare ORI monitoring against standard SpO2 monitoring during ETI; outcomes include the lowest SpO2 during intubation and cognitive
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  • - This study examined adherence to the "Guidelines for Prehospital Emergency Anesthesia in Adults" in Aachen, Germany, focusing on key aspects like decision-making, intubation attempts, and medication use over two years, involving 127 adult patients.
  • - Out of those patients, 29 did not receive prehospital emergency anesthesia despite being eligible, while 98 were successfully intubated, showing good adherence to monitoring and medication guidelines.
  • - A significant improvement in oxygen saturation was noted after anesthesia induction, but further research is needed to understand why some eligible patients did not receive the treatment.
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Comparison of a videolaryngoscope with a 3D-printed angled blade and a direct laryngoscope with a Macintosh blade for rapid sequence tracheal intubation: An observational study.

Eur J Anaesthesiol

December 2024

From the Postgraduate Programme in Medical Sciences, Universidade Federal Fluminense, Rua Desembargador Athayde Parreiras, 100, Bairro de Fátima, Niterói, RJ, Brazil (AJS, ILC), Department of Surgery, Postgraduate Programme in Surgical Sciences, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, Rio de Janeiro, RJ, Brazil (NV), and Department of General and Specialised Surgery, Universidade Federal Fluminense, Rua Desembargador Athayde Parreiras, 100, Bairro de Fátima, Niterói, RJ, Brazil (MACR).

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Tracheal laceration following rapid sequence intubation.

J Bras Pneumol

August 2024

. Serviço de Pneumologia, Unidade Local de Saúde da Guarda EPE, Guarda, Portugal.

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  • The study evaluated the learning curve for tracheal intubation among Pediatric Emergency Medicine (PEM) fellows, focusing on their success rates during training.
  • Over a six-year period, 36 PEM fellows attempted tracheal intubation in 414 patient encounters, achieving a first attempt success rate of 67% and an overall success rate of 81%.
  • None of the fellows reached the desired performance threshold of 90%, indicating that despite frequent attempts, they struggled to meet established proficiency standards for this critical procedure.*
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  • The study investigates the cardiovascular effects of different doses of alfentanil combined with propofol and etomidate during rapid sequence intubation (RSI) in elderly patients aged 65-80, addressing a gap due to the lack of standardized protocols for this demographic.
  • A total of 96 patients were randomly assigned to four groups receiving varying doses of alfentanil (10-25 µg/kg), with key cardiovascular metrics measured before and after anaesthesia induction and intubation.
  • Results showed that lower doses (10-15 µg/kg) caused an increase in heart rate and blood pressure, while higher doses (20-25 µg/kg) exhibited mixed cardiovascular responses, indicating the complexity of managing anaesthesia in older
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  • Airway management is a crucial skill for EMS clinicians, particularly for treating pediatric patients, and this study analyzed pediatric cases using the 2019 ESO data set.
  • Out of over 7 million EMS activations, 346,912 involved pediatric patients, with 27,071 encounters requiring airway management interventions such as bag-valve-mask ventilation and intubation.
  • Despite the interventions, advanced airway management happened infrequently, and success rates for tracheal intubation were notably low, highlighting the need for improved training and protocols in pediatric emergency care.
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  • Universal use of Storz C-MAC® videolaryngoscopes for adult tracheal intubations was adopted at Royal United Hospitals Bath NHS Foundation Trust in 2017, covering various medical settings, and data was collected from 1,099 procedures between March 2020 and March 2022.
  • The overall intubation success rate was 100%, with a first-pass success rate of 87.3%, varying by device type and user experience, and 87% of attempts resulted in no complications, particularly high in operating theatres and the emergency department.
  • Complications were rare, occurring in only 0.6% of cases, primarily outside theatres and during rapid sequence induction, highlighting the impact of
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[Indications and success rate of endotracheal emergency intubation in clinical acute and emergency medicine].

Anaesthesiologie

August 2024

Zentrum für klinische Akut- und Notfallmedizin, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Viersener Straße 450, 41063, Mönchengladbach, Deutschland.

Article Synopsis
  • This study examines endotracheal intubation (ETI) practices and outcomes in the emergency department of a hospital in Germany, focusing on success and complication rates from January 2020 to June 2023.
  • A total of 499 patients were successfully intubated with a primary success rate of 98%, and a first pass success rate of 97.4%.
  • The presence of consultant vs. resident ED staff did not show significant differences in intubation success rates, suggesting that both groups were equally effective.
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Alfentanil versus fentanyl for emergency department rapid sequence induction with ketamine: A-FAKT, a pilot randomized trial.

Am J Emerg Med

October 2024

South Western Sydney Clinical School, University of New South Wales, Warwick Farm, New South Wales, Australia; Aeromedical Operations, New South Wales Ambulance, Bankstown Aerodrome, New South Wales, Australia; Emergency Department, Liverpool Hospital, Liverpool, New South Wales, Australia.

Article Synopsis
  • Fentanyl is commonly used during rapid sequence induction (RSI) in the emergency department to manage hypertension, but this study compares it with alfentanil, which may have a quicker onset.
  • The research involved a double-blind trial with 61 adult patients randomized to receive either alfentanil or fentanyl, measuring blood pressure and heart rate after induction to assess their effects on hemodynamic changes.
  • Results showed no significant differences between the two drugs in terms of blood pressure, heart rate, or other complications, indicating that both alfentanil and fentanyl can be used effectively in this context.
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  • Situational awareness is crucial for paramedics during emergency procedures like endotracheal intubation, and previous studies have indicated that time distortion may occur, but mostly in hospital settings with physicians.
  • This study aimed to investigate if paramedics experience time distortion as well, by comparing their perceived versus actual laryngoscopy times during pre-hospital intubations.
  • The results showed that the average perceived laryngoscopy time (27.8 seconds) was significantly shorter than the actual time (50.0 seconds), highlighting a notable difference in perception during emergencies.
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  • An emergent front of neck airway (FONA) is essential in 'can't intubate, can't oxygenate' scenarios and can sometimes be the primary airway management method; surgical techniques for FONA are generally preferred.
  • This study analyzed FONA instances in Finnish helicopter emergency medical services (HEMS) from 2012 to 2019, finding a low overall incidence, with only 22 cases reported.
  • Although FONA was successful in all attempts, on-scene mortality was notable at 36%, and 30-day mortality reached 90%, highlighting the serious nature of situations requiring this intervention.*
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  • A study compared two periods: one without intensivist staffing and one with, revealing a significant increase in first-pass success rates and better compliance with emergency protocols during the staffed period.
  • Results indicated earlier intubation decisions and reduced post-intubation complications, highlighting the importance of having dedicated intensivists in improving patient safety and MET performance.
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The role of supraglottic airway devices for caesarean section under general anaesthesia. A scoping literature review with a proposed algorithm for the appropriate use of supraglottic airway devices for caesarean sections.

Eur J Anaesthesiol

September 2024

From the Department of Anaesthesia, Hillingdon Hospital, London, UK (US), the Department of Anaesthesiology, UZLeuven, Leuven (KJ), the Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex, London, UK (NL), the Department of Cardiovascular Sciences, KULeuven (MVdV), and the Department of Anaesthesiology, UZLeuven, Leuven, Belgium (MVdV).

Article Synopsis
  • This review examines the effectiveness of supraglottic airway devices (SGA) for managing airways in pregnant patients undergoing caesarean sections, highlighting the challenges posed by physiological changes during pregnancy.
  • It discusses the standard practice of rapid sequence induction and tracheal intubation, while also noting evidence that second-generation SGA devices can be effective and well-tolerated in specific cases.
  • The analysis included 13 manuscripts with data from 7722 patients, reporting a low incidence of complications, with only a few failures in SGA insertion and no instances of pulmonary aspiration.
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Correlating Simulation Training and Assessment With Clinical Performance: A Feasibility Study.

Air Med J

June 2024

Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Ornge, Mississauga, Ontario, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.

Article Synopsis
  • The study aimed to evaluate the challenges of linking simulation assessments for airway management with actual clinical performance among paramedics in Ontario.
  • It used logistic regression to analyze the relationship between paramedics' assessment scores and their success rates in performing rapid sequence intubation in real-life scenarios.
  • While results showed varied success rates based on different bases and assessment scores, the study concluded that a larger sample size is needed for definitive conclusions and outlined areas for future research.
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A new pharmacological approach for tracheal intubation?

Br J Anaesth

July 2024

Faculty of Medicine and Dentistry, University of Plymouth, John Bull Building, Plymouth Science Park, Plymouth, UK. Electronic address:

Article Synopsis
  • - Anaesthesia can be induced using remimazolam and a fentanyl-based opioid, which can then be reversed with flumazenil and naloxone.
  • - Tracheal intubation can be assisted through paralysis with rocuronium, which is reversible using sugammadex.
  • - The combined use of these drugs allows for full reversibility during anaesthesia induction, but its safety and practicality need thorough assessment.
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