scholarly journals Airway Management in the Pre-Hospital Setting

2020 ◽  
Author(s):  
Lamia Tawfik ◽  
Mohammad Al Nobani ◽  
Tarek Tageldin
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Rapid Sequence Intubation ◽  
Medical Providers ◽  
Rapid Sequence ◽  
Research Findings

This chapter explores the different techniques and challenges faced by emergency medical providers during pre-hospital airway management of critically ill patients. It is a crucial topic that has a major impact on patient’s safety. Improper airway management in this category of patients can lead to catastrophic results in terms of morbidity and mortality, this fact stimulates the ongoing improvement and evolution in this area of practice. We explore some of the debatable topics in pre-hospital airway management like airway management in the pediatric group, the use of medication assisted intubation and rapid sequence intubation in the field as well as the role of video assisted intubation and it’s challenges in the field. The up-to-date practices and research findings in the most recent related articles are discussed here in this chapter.

scholarly journals Pro-Con Debate: Etomidate or Ketamine for Rapid Sequence Intubation in Pediatric Patients

2012 ◽  
Vol 17 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Daniel Scherzer ◽  
Mark Leder ◽  
Joseph D. Tobias
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Safety Concern ◽  
Essential Element ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Critically Ill Children ◽  
Rapid Sequence Intubation ◽  
Airway Control ◽  
Rapid Sequence

When caring for critically ill children, airway management remains a primary determinant of the eventual outcome. Airway control with endotracheal intubation is frequently necessary. Rapid sequence intubation (RSI) is generally used in emergency airway management to protect the airway from passive regurgitation of gastric contents. Along with a rapid acting neuromuscular blocking agent, sedation is an essential element of RSI. A significant safety concern regarding sedatives is the risk of hypotension and cardiovascular collapse, especially in critically ill patients or those with pre-existing comorbid conditions. Ketamine and etomidate, both of which provide effective sedation with limited effects on hemodynamic function, have become increasingly popular as induction agents for RSI. However, experience and clinical investigations have raised safety concerns associated with both etomidate and ketamine. Using a pro-con debate style, the following manuscript discusses the use of ketamine versus etomidate in RSI.

Rapid Sequence Intubation Improves Extubation Rates for Emergently Intubated Critically Ill Patients

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 198A ◽  
Author(s):  
Kavan Ramachandran ◽  
Kishan Ramachandran ◽  
Prashant Gundre ◽  
Yizhak Kupfer ◽  
Chanaka Seneviratne ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Sequence Intubation ◽  
Rapid Sequence

Airway Management

2019 ◽  
Author(s):  
James M. Dargin ◽  
Lillian L. Emlet
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Critically Ill Patients ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Bag Mask Ventilation ◽  
Upper Gastrointestinal

Endotracheal intubation is a commonly performed procedure in the intensive care unit (ICU). Active upper gastrointestinal bleeding, emesis in the airway, and the presence of a cervical collar are just a few examples of conditions encountered in critically ill patients that can make endotracheal intubation difficult. Furthermore, critically ill patients usually require intubation because they have exhausted their physiologic reserve and can deteriorate rapidly due to vasodilation from induction medications, reduction in preload from positive pressure ventilation, hypercapnia and acidosis during periods of apnea, hypoxia from failed attempts at intubation, and an increase in intracranial pressure during laryngoscopy attempts. Up to one third of patients undergoing emergency airway management will develop serious complications, including hypoxemia, hypotension, aspiration, or cardiac arrest. Careful planning, provision of the appropriate equipment and personnel, and an understanding of an individual patient’s physiologic derangements can help to prevent complications during intubation.  This review 13 figures, 4 tables, and 27 references.  Keywords: airway, intubation, endotracheal, rapid sequence, pre-oxygenation, bag-mask ventilation, laryngoscopy, cricothyrotomy, supraglottic airway 

913: Increased Mortality With Succinylcholine for Rapid Sequence Intubation in Critically Ill Patients

2020 ◽  
Vol 49 (1) ◽  
pp. 453-453
Author(s):  
Emily Bodin ◽  
Molly Howell ◽  
Todd Walroth ◽  
David Foster ◽  
Serena Dine ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Sequence Intubation ◽  
Rapid Sequence

scholarly journals (A179) A Survey of Rapid Sequence Intubation (RSI) Complications in Immam Hossein Medical Center Carried Out by Emergency Residents

2011 ◽  
Vol 26 (S1) ◽  
pp. s51-s52
Author(s):  
H. Hatamabadi ◽  
I. Golkhatir ◽  
A. Amini ◽  
M. Alavi Moghadam
Keyword(s):  
Emergency Medicine ◽  
Success Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Rapid Sequence Intubation ◽  
Emergency Airway ◽  
Emergency Medicine Resident ◽  
Rapid Sequence ◽  
Significant Difference

IntroductionCritically ill patients in emergency department frequently require emergency airway management. This procedure in our ED is carried out by emergency medicine resident with rapid sequence intubation (RSI). This study investigates complications of tracheal intubation carried out in critically ill patients including: (1) hypoxemia and hypotension (2) aspiration and esophageal displacement (3) pneumothorax and right bronchus intubation.MethodsData were collected on consecutive intubations carried out by EM residents over a 29 months period. Between 195 patients only 100 patients had including criteria to enter this study. Also we compare the complications and success rate among three level of personnel carrying on the procedure.(first to third year of emergency medicine residency).Results109 consecutive intubations were carried on in 100 patients. Oral translaryngeal intubation was done in all patients. Three intubations required more than 2 attempts and hypoxia occurred in 34 cases. Aspiration was diagnosed by direct vision in 5 cases. Hypotension was found in 5 cases causing death in 3 of them during the intubation or in 30 minutes following the procedure. Esophageal displacement occurred in 10 of the attempts but all were recognized and reintubated. Success rate between three personnel levels are as follow: in first year residency 82% and in second year residency 94% and in third year residency is 100% (p = 0.014).There was not a statistically significant difference among these three groups considering the complications but the success rate should a difference between level 1 and 3 (p = 0.936). Multiple attempts did not increase the rate of complications. Mortality were dependent to hypotension (p = 0.019) and age (p = 0.001).ConclusionIn our study we did not find the results of RSI to be operator dependent as long as it was done by emergency residents. It is recommended to compare the results of RSI and non- RSI methods in a future.

scholarly journals Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Péricles A. D. Duarte ◽  
Gustavo Elias Leichtweis ◽  
Luiza Andriolo ◽  
Yasmim A. Delevatti ◽  
Amaury C. Jorge ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Critically Ill ◽  
Low Income ◽  
Critically Ill Patients ◽  
Morbidity And Mortality ◽  
Low Income Countries ◽  
Vasoactive Drugs ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background. Acute Atrial Fibrillation (AF) is common in critically ill patients, with significant morbidity and mortality; however, its incidence and severity in Intensive Care Units (ICUs) from low-income countries are poorly studied. Additionally, impact of vasoactive drugs on its incidence and severity is still not understood. This study aimed to assess epidemiology and risk factors for acute new-onset AF in critically ill adult patients and the role of vasoactive drugs. Method. Cohort performed in seven general ICUs (including cardiac surgery) in three cities in Paraná State (southern Brazil) for 45 days. Patients were followed until hospital discharge. Results. Among 430 patients evaluated, the incidence of acute new-onset AF was 11.2%. Patients with AF had higher ICU and hospital mortality. Vasoactive drugs use (norepinephrine and dobutamine) was correlated with higher incidence of AF and higher mortality in patients with AF; vasopressin (though used in few patients) had no effect on development of AF. Conclusions. In general ICU patients, incidence of new-onset AF was 11.2% with a high impact on morbidity and mortality, particularly associated with the presence of Acute Renal Failure. The use of vasoactive drugs (norepinephrine and dobutamine) could lead to a higher incidence of new-onset AF-associated morbidity and mortality.

scholarly journals Serum Procalcitonin Level and Mortality Risk in Critically ill Patients with Ventilator-Associated Pneumonia

2015 ◽  
Vol 37 (5) ◽  
pp. 1967-1972 ◽  
Author(s):  
Bo Li ◽  
Xin Zhao ◽  
Shumei Li
Keyword(s):  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
High Serum ◽  
Ventilator Associated Pneumonia ◽  
Prognostic Role ◽  
Procalcitonin Level ◽  
Increased Risk

Background/Aims: The prognostic role of serum procalcitonin level in critically ill patients with ventilator-associated pneumonia was unclear. The aim of our study was to investigate the relationship between serum procalcitonin level and mortality risk in critically ill patients with ventilator-associated pneumonia. Methods: Data of critically ill patients with ventilator-associated pneumonia were retrospectively collected. Demographics, comorbidities, and serum procalcitonin level were extracted from electronic medical records. The primary outcome was mortality within two months after diagnosis. Multivariable Cox regression analyses were performed to assess the prognostic role of serum procalcitonin level in those patients. Results: A total of 115 critically ill patients with ventilator-associated pneumonia were enrolled in our study. Serum procalcitonin level was not associated with age, gender, or other comorbidities. Univariate Cox regression model showed that high serum procalcitonin level was associated increased risk of morality within 2 months after diagnosis (OR = 2.32, 95% CI 1.25-4.31, P = 0.008). Multivariable Cox regression model showed that high serum procalcitonin level was independently associated increased risk of morality within 2 months after diagnosis (OR = 2.38, 95% CI 1.26-4.50, P = 0.008). Conclusion: High serum procalcitonin level is an independent prognostic biomarker of mortality risk in critically ill patients with ventilator-associated pneumonia, and it's a promising biomarker of prognosis in critically ill patients.

scholarly journals Do Aspirin and Other Antiplatelet Drugs Reduce the Mortality in Critically Ill Patients?

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Wolfgang Lösche ◽  
Janina Boettel ◽  
Björn Kabisch ◽  
Johannes Winning ◽  
Ralf A. Claus ◽  
...  
Keyword(s):  
Organ Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Option ◽  
Bleeding Risk ◽  
Antiplatelet Drugs ◽  
Beneficial Effects ◽  
Prospective Trials ◽  
High Bleeding Risk

Platelet activation has been implicated in microvascular thrombosis and organ failure in critically ill patients. In the first part the present paper summarises important data on the role of platelets in systemic inflammation and sepsis as well as on the beneficial effects of antiplatelet drugs in animal models of sepsis. In the second part the data of retrospective and prospective observational clinical studies on the effect of aspirin and other antiplatelet drugs in critically ill patients are reviewed. All of these studies have shown that aspirin and other antiplatelet drugs may reduce organ failure and mortality in these patients, even in case of high bleeding risk. From the data reviewed here interventional prospective trials are needed to test whether aspirin and other antiplatelet drugs might offer a novel therapeutic option to prevent organ failure in critically ill patients.

Sign in / Sign up

Export Citation Format

Share Document