Ce qu’il faut retenir de 2017

By :

Nicolas PESCHANSKI, MD, PhD

Emergency Physician. FOAMed Supporter

Research Manager. Emergency Department, SAMU and MICU

Evreux Eure-Seine General Hospital. Normandy, France 

Articles at the Top. Take home messages from 2017 (part 1).

25DIC

Welcome to our annual review of the best articles from the past year.

This will be a weekly (or so..) appointment with the top (or so…) articles of 2017 divided by topic and chosen by me.

At the end of the post I will also mention some take home points as summary of the evidences emerged from the articles.

And now here is the best (for me) about:

Airway management

Here are the best articles of the past year about Airway Management:

  • Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study
  • Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis
  • Intubation using apnoeic oxygenation to prevent desaturation: A systematic review and meta-analysis
  • Effectiveness of Apneic Oxygenation During Intubation: A Systematic Review and Meta-analysis
  • A prospective, randomised trial of pre-oxygenation strategies available in the pre-hospital environment
  • Maintenance of Oxygenation during Rapid Sequence Intubation in the Emergency Department
  • Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis
  • Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review
  • Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT IIIP
  • The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis
  • Pre-hospital Supraglottic Airway was Associated with Good Neurological Outcome in Cardiac Arrest Victims Especially Who Received Prolonged Cardiopulmonary Resuscitation.
  • Theeffectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study
  • Avoidance versus use of neuromuscular blocking agents for improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents (Cochrane review)
  • The Impact of Prehospital Intubation With and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less
  • Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review
  • Effect of patient weight on first pass success and neuromuscular blocking agent dosing for rapid sequence intubation in the emergency department
  • Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications
  • Managing Initial Mechanical Ventilation in the Emergency Department
  • The myth of the difficult airway: airway management revisited
  • Strategies for the prevention of airway complications – a narrative review
  • Airway Management in Trauma

 

My take home messages about airway management:

  1. Risk factorsfor intubation related cardiac arrest are: overweight or obesity, age more than 75 years old, low SBP prior to intubation, hypoxemia prior to intubation, and absence of preoxygenation before intubation procedure.
  2. Preoxygenationis crucial (at least 2 minutes), before paralysing, to extend safe apnea time.
  3. Use apneic oxygenationduring intubation attempts.
  4. Tracheal intubationis good in the hands of very well skilled professionals. Otherwise can improve mortality rate.
  5. Supraglottic devicesperform well in cardiac arrest and are a valuable option for airway management. 
  6. Videolaryngoscopyimprove glottic view but need training to improve first pass success.
  7. Always use paralyticswhen intubating a non-cardiac arrest patient. It improves the chances fo first pass success.
  8. Rocuronium and Succynocholineare both valuable options for paralysis in airway management. 
  9. Dose Succynocholine,and other depolarising neuromuscular blockade drugs, based on actual body weight. Dose Rocuronium or Vecuronium based on ideal body weight.
  10. Use cuffed tracheal tubes even in paediatric They perform well and  complications rate is the same. 
  11. The difficult airway is a myth. It’s not  a matter of technique but of decision making.

 

 

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