A couple of days ago, I published a podcast on the PREOXI Trial. My buddies got back to me with a bunch of thoughts and comments. In this wee, I respond with additional thoughts.
Stuff Mentioned
- PreVent: Casey JD, Janz DR, Russell DW, et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. The New England journal of medicine. 2019; 380(9):811-821. PMID: 30779528
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Great cast!! Physicians are taught to be resourceful and make all sorts of work-arounds to get the job done. Especially EM and CCM types – where we are often forced to make do with whatever we have. Occasionally this make-do, flexible mindset serves us poorly. In this situation, I think we should demand that NIV become a standard protocol. It’s the best thing for our patients. With a little training and culture shift it will be easy to provide. If you get pushback about the cost of extra masks, please note that a malpractice suit for airway loss averages ~2.5… Read more »
Once people accept that the things that will impact oxygenation are FiO2 and mean airway pressure outside of shunting situations they will be able to figure what is best in their situation from first principles. Some appreciation that maximal inspiratory flow rate determines FiO2 if it exceeds flow rate of oxygen delivered is helpful but tricky to understand in open circuits like non-rebreathers so why use them. Determinants of oxygenation would be a neat podcast to hear. Shunts are a rabbit hole that is probably a whole other podcast…… Atelectasis (one cause of shunt) after induction is almost guaranteed so… Read more »
Hi there all, Just curious to ask the hive mind what you all think the practical implications are for our prehospital paramedic colleagues managing airways in the field? Certainly BVM + NC + PEEP valve +apneic ventilation is meeting the minimum standards set by the trial, but do we need to truly push for a dedicated NIV platform that can do I and EPAP with a backup rate? Is it worth pushing places that only have CPAP and not BiPAP in their EMS scope of practice to change the rules? Can we expect to deploy a true ventilator to the… Read more »
Can someone help me understand why the cardiac arrest 2 mins after intubation isn’t misleading?