"Rapid Sequence Intubation"

PURPOSE: Postintubation hypotension (PIH) is a recognized complication that increases both in-hospital mortality and hospital length of stay. Sepsis is reportedly a factor associated with PIH. However, no study to date has examined which factors, including the intubation method, may be clinical predictors of PIH in patients with sepsis. This study aims to investigate factors associated with the occurrence of PIH in patients with suspected sepsis in emergency department. PATIENTS AND METHODS: This retrospective cross-sectional study was performed over a 5-year period (January 2013-December 2017) and involved patients with suspected sepsis who underwent endotracheal intubation in the emergency department of Ramathibodi Hospital...

OBJECTIVE: Rapid sequence intubation (RSI) is frequently performed by emergency medical services (EMS). We investigated the relationship between succinylcholine and rocuronium use and time until first laryngoscopy attempt, first-pass success, and Cormack-Lehane (CL) grades. METHODS: We included adult patients for whom prehospital RSI was attempted from July 2015 through June 2022 in a retrospective, observational study with pre-post analysis. Timing was verified using recorded defibrillator audio in addition to review of continuous ECG, pulse oximetry, and end-tidal carbon dioxide waveforms...

OBJECTIVE: To describe the effects of different induction agents on the incidence of post-induction hypotension (PIH) and its associated interventions during rapid sequence intubation (RSI) in the ED. METHODS: A single centre retrospective study of patients intubated between 2018 and 2021 was conducted in a regional Australian ED. The impact of induction agent choice, in addition to demographic and clinical factors on the incidence of PIH were determined using descriptive statistics and a multivariate analysis presented as adjusted odds ratios (aORs) and their 95% confidence intervals (CIs)...

BACKGROUND: Bag-Mask Ventilation (BMV) is a crucial skill in managing emergency airway situations and induction of general anesthesia. Ensuring proficient BMV execution is imperative for healthcare providers. Various techniques exist for performing BMV. This study aims to compare the quality of ventilation achieved using the E/C technique, Thenar Eminence (T/E) technique and a novel approach referred to as the hook technique. The goal is to identify the most effective single-person BMV method...

In 1993, the Southwest found itself staring down a disease then known as "unexplained adult respiratory syndrome." During the outbreak, 12 of 23 known patients died. What we now recognize as hantavirus cardiopulmonary syndrome still remains a rare and deadly disease. Although no cure exists, modern supportive techniques such as extracorporeal membrane oxygenation have increased survival among these patients. Early diagnosis has become the primary factor in patient survival. The initial presentation of hantavirus is similar to acute respiratory distress syndrome, necessitating a high index of suspicion to afford the patient the best chance of survival...

BACKGROUND: Mechanical ventilation (MV) management is an essential skill for pulmonary and critical care medicine (PCCM) fellows to master during training. The unprecedented emergence of the coronavirus disease (COVID-19) pandemic highlighted the need for advanced operator competency in MV to improve patients' outcomes. OBJECTIVE: We aimed to create a standardized case-based curriculum using a blended approach of high-fidelity simulation, rapid-cycle deliberate practice, video didactics, and hands-on small group sessions for rapid accumulation of knowledge and hands-on skills for PCCM fellows before caring for critically ill patients during the COVID-19 pandemic...

INTRODUCTION: Quality improvement (QI) is a major focus of all departments and fields of health care, including emergency medical services. The chaotic and rapidly evolving atmosphere in which paramedics must practice can lead to inconsistency between what is documented and the actual events. This leads to difficulty when trying to evaluate the practitioners and when implementing a QI program. In this study, we evaluated the prevalence of discrepancy between the video and written record for Rapid Sequence Intubation (RSI) performed in the field as a demonstration of the utility of video documentation in QI...

BACKGROUND: The use of induction agents for rapid sequence intubation (RSI) has been associated with hypotension in critically ill patients. Choice of induction agent may be important and the most commonly used agents are etomidate and ketamine. OBJECTIVE: This study aimed to compare the effects of a single dose of ketamine vs. etomidate for RSI on maximum Sequential Organ Failure Assessment (SOFA) score and incidence of hypotension. METHODS: This single-center, randomized, parallel-group trial compared the use of ketamine and etomidate for RSI in critically ill adult patients in the emergency department...

RATIONALE: Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). OBJECTIVES: To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. DESIGN: A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel's inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress...

No abstract text is available yet for this article.

BACKGROUND: Facilitated intubation (FI) refers to intubation performed using a sedative or anesthetic drug as an induction agent, without the use of a paralytic (neuromuscular blocking agent). In comparison, rapid sequence intubation (RSI) employs both an induction agent and a paralytic drug. RSI has been seen to outperform FI in terms of first-pass success when performing direct laryngoscopy and was quickly adopted as the gold standard in all situations. Recently, ketamine-only intubation has been used in situations where there is distorted anatomy or apnea intolerance (physically and physiologically difficult airways) resulting in an increased risk of a can't intubate/can't oxygenate scenario or significant hypoxemia...

A 72-year-old female with symptomatic cholelithiasis was posted for laparoscopic cholecystectomy. She had been previously posted for the same surgery at a different center, but the surgery was not performed due to failed intubation. On airway examination, reduced thyromental distance, prominent incisors, and retrognathia were observed. We planned and executed rapid sequence intubation under videolaryngoscope guidance using The Anaesthetist Society Scope, and the surgery proceeded uneventfully. At the end of the surgery, she was extubated over a bougie, observed, and shifted out without complications...

INTRODUCTION: The use of paralytics during rapid sequence intubation (RSI) in patients with myasthenia gravis (MG) remains a controversial topic in emergency medicine. Due to fewer functional acetylcholine receptors, these patients can be both sensitive and resistant to different types of neuromuscular blocking agents (NMBA). Their atypical sensitivity to non-depolarizing NMBAs such as rocuronium can increase both the duration and depth of paralysis after its use at typical RSI doses...

OBJECTIVE: To review the efficacy, safety, and place in therapy of fentanyl as an induction agent for rapid sequence intubation (RSI) in critically ill patients. DATA SOURCES: A comprehensive search of PubMed, EMBASE, and clinical trial registries (1964-June 2021) was performed utilizing the keywords fentanyl, rapid sequence intubation, intubation, induction, anesthesia, hemodynamics, operating room (OR), and emergency. STUDY SELECTION AND DATA EXTRACTION: Only primary literature evaluating fentanyl in combination with a sedative or as the sole induction agent was included in the final analysis...

BACKGROUND: Prehospital endotracheal intubation is a debated topic, and few studies have found it beneficial after trauma. A growing body of evidence suggests that prehospital endotracheal intubation is associated with increased morbidity and mortality. Our study was designed to compare patients with attempted prehospital endotracheal intubation to those intubated promptly upon emergency department arrival. METHODS: A retrospective review of a single-center trauma research data repository was utilized...

INTRODUCTION: Difficult laryngoscopy and intubation are serious problems among critically ill patients in emergency department (ED) so utility of a rapid, accurate and noninvasive method for predicting of these patients are necessary. Ultrasonography has been recently used in this regard and this study was conducted to investigate the correlation of some introduced upper airway ultrasound parameters with difficult laryngoscopy / difficult intubation in patients referred to the ED. METHOD: In this prospective observational study all patients ≥ 18-year-old who had an indication for rapid sequence intubation (RSI) were included...

BACKGROUND: Rapid sequence intubation (RSI) is a technique that allows patients to be quickly intubated and have the airway secured. AIMS: The purpose of this study was to investigate the effect of rocuronium priming and intubation dose calculated according to actual body weight (ABW) or corrected body weight (CBW) on the neuromuscular block and intubation quality in rapid sequence induction and intubation (RSII). PATIENTS AND METHODS: This prospective randomized, double-blind study was conducted on a total of 60 patients randomized into two groups using the closed-envelope method between January 2021 and December 2021, with 30 individuals in each group...

STUDY OBJECTIVE: For patients with hemodynamic instability undergoing rapid sequence intubation, experts recommend reducing the sedative medication dose to minimize the risk of further hemodynamic deterioration. Scant data support this practice for etomidate and ketamine. We sought to determine if the dose of etomidate or ketamine was independently associated with postintubation hypotension. METHODS: We analyzed data from the National Emergency Airway Registry from January 2016 to December 2018...

The case presented here highlights the utility/feasibility of the SEADUC (EM Innovations, Galloway, OH) manual suction unit in clearing a contaminated airway during rapid sequence intubation. The case also highlights the importance of intubation in a patient with declining mental status in the prehospital environment. A 75-year-old woman suffered a head injury, and a helicopter emergency medical service team staffed with a physician and nurse was tasked with retrieval and transfer back to the tertiary care center...

BACKGROUND: Succinylcholine and rocuronium are the most commonly utilized neuromuscular blocker agents (NMBAs) for rapid sequence intubation (RSI) in the emergency department (ED). The duration of action of rocuronium is significantly longer (∼30 min) compared to succinylcholine (∼10 min) and previous studies have shown that patients receiving rocuronium are more likely to have longer time to sedation initiation following RSI. Furthermore, patients receiving rocuronium may be more likely to experience awareness with paralysis than those receiving succinylcholine...