Category: Mechanical ventilation

Difficult airway characteristics associated with video laryngoscopy failure

Raj Joshi , Cameron D. Hypes,  Jarrod M. Mosier et el published a single center prospective observational study looking at the risk factors for failure of first attempt at intubation using video laryngoscopy in intensive care unit.   Background Macintosh (1943) and Miller (1941) developed direct laryngoscopes and paved the way for modern direct laryngoscopy.  Mainstay of …

Read More Difficult airway characteristics associated with video laryngoscopy failure

Conservative Vs Conventional Oxygen therapy : How much or how low ?

Massimo Girardis, Stefano Busani and Mervin Singer et el  published a single center study in October, 2016 issue of JAMA comparing conservative oxygen therapy with conventional one in critically ill patients.    Who All adult patients admitted to an ICU in Italian hospital from 2010 to 2012. Following were excluded pregnancy, ICU readmission, a decision to withhold life-sustaining …

Read More Conservative Vs Conventional Oxygen therapy : How much or how low ?

Timing of intubation for in hospital cardiac arrest ?

Traditional wisdom taught us to secure airway as soon as possible in case of cardiac arrest(at least in hospital arrest), though over the course of years, American hearth association have moved their focus from “ABC” (airway-breathing-circulation) to “CAB” (circulation-airway-breathing). AHA also suggested that if a trained individual is not present to secure airway, bag mask ventilation …

Read More Timing of intubation for in hospital cardiac arrest ?

What the hell is EIP ?

Low tidal volume ventilation in ARDS (acute respiratory distress syndrome) have been shown to improve mortality. However, low tidal volume ventilation invariably leads to hypercapnia. Many strategies have been employed to optimize the ventilation in ARDS using increases in respiratory rate , use of active humidifiers  and the tracheal gas insufflation or aspiration of dead space. …

Read More What the hell is EIP ?

You may want this drug in your RSI box!

Finally, an alternative to Succinylcholine in USA (short duration paralytic)   In December, 2015, FDA approved Bridion (sugammadex) injection to reverse the effects of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide. Now finally we have an alternative to succinylcholine (Mainly used for its very short duration of action).(1)   “Bridion provides a new treatment …

Read More You may want this drug in your RSI box!

Effective communication with mechanically ventilated patients

S. Ten Hoorn, P. W. Elbers and A. R. Girbes published a systemic review in critical care journal in Sept, 2016 about how to communicate with patients on mechanical ventilation.  Summary of the review is in this picture In the US, many ICUs use commercially available communication boards. One below is from Vidatak. In the current technology driven era, there are many …

Read More Effective communication with mechanically ventilated patients

New recommendations for liberation from mechanical ventilation

Chest/ American thoracic society released new guidelines for liberation from mechanical ventilation. There are six key recommendations. They all are applicable to patients who are mechanically ventilated for more than 24 hours. For all recommendations, strength is conditional except recommendation for NIV after extubation where it is strong. Initial SBT or spontaneous breathing trial should …

Read More New recommendations for liberation from mechanical ventilation

Should you extubate during night ? Yes, if you are there!

Gershengorn et al published in JAMA a very large retrospective cohort study of 97 844 patients from 165 US ICUs who participate in Project Impact from October 1, 2000, to March 29, 2009. Authors created  4518 propensity-matched pairs of patients with less than 12 hours of Mechanical ventilation and 5761 propensity-matched pairs of patients with mechanical ventilation of more …

Read More Should you extubate during night ? Yes, if you are there!