Respiratory Failure & Mechanical Ventilation

I completed Quiz: 2️⃣ Control Variables!

I completed 2️⃣ Control Variables!

I completed 1️⃣ Breath Phases!

The desired position of an ETT is 5 ± 2 cm above the carina, but markedly varies with neck position and rotation and hence, the inclusion of the mandible is a helpful indicator:

• flexed: 3 cm (± 2 cm) above carina

• neutral: 5 cm (± 2 cm) above carina

• extended: 7 cm (± 2 cm) above carina

@Everyone

Tight squeeze of ETT through edematous cords! You can see evaporation nicely confirming position!

Videolaryngoscope versus Conventional Technique for Insertion of a Transesophageal Echocardiography Probe in Intubated ICU Patients (VIDLARECO trial). A Randomized Clinical trial - ScienceDirect

In a trial with 100 intubated critically ill patients, the use of a videolaryngoscope for transesophageal echocardiogram probe insertion significantly increased first-attempt success rates (90% vs. 58%, p < 0.001) and overall success (100% vs. 72%, p < 0.001), compared to the conventional method. Additionally, the videolaryngoscope group experienced notably fewer pharyngeal complications (14% vs. 52%, p < 0.001), demonstrating its efficacy and safety over traditional techniques in this patient population.

This is a case of tracheostomy insertion via a percutaneous approach. What complication did you notice? Have you experienced any similar complication with this procedure?

Share your answer and thoughts in the comment section!

Emulating Target Trials Comparing Early and Delayed Intubation Strategies

The appropriateness of initiating intubation early in critically ill patients has been a topic of contention, with previous observational studies yielding ambiguous results due to various flaws such as immortal time bias, unfitting eligibility criteria, and unrealistic treatment strategies. This study aimed to discern if treatment strategies that promote early intubation upon critical care admission enhance 30-day survival as opposed to those that advocate for delayed intubation. Leveraging data from the Medical Information Mart for Intensive Care-IV database, three target trials were emulated, each differing in treatment strategy flexibility and baseline eligibility criteria. The findings revealed that under exceedingly strict treatment strategies coupled with broad eligibility criteria, the 30-day mortality risk was 7.1 percentage points higher for early intubation than for delayed intubation (95% CI, 6.2-7.9). However, subsequent target trial emulations with more pragmatic treatment strategies and eligibility criteria displayed risk…

Optimizing Intubation Success: A Comparative Study of Video and Direct Laryngoscopy in Critically Ill Adults (The DEVICE Trial)

This multicenter, randomized trial evaluated the effectiveness and safety of video laryngoscopy compared to direct laryngoscopy in critically ill adults undergoing tracheal intubation in emergency departments and intensive care units (ICUs). The study aimed to determine if video laryngoscopy increases the likelihood of successful first-attempt tracheal intubation and whether it impacts the occurrence of severe complications during intubation.

The study included 1,417 patients. The primary outcome, successful first-attempt intubation, occurred in 85.1% of the video-laryngoscope group, significantly higher than the 70.8% success rate in the direct-laryngoscope group. The secondary outcome, severe complications during intubation (e.g., severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death), was similar between the two groups. Other safety outcomes, such as esophageal intubation, injury to the teeth, and aspiration, were also comparable in both…