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Tag: intubation

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Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient

Acquisto NM, Mosier JM, Bittner EA, et al. Society of Critical Care Medicine clinical practice guidelines for rapid sequence intubation in the critically ill adult patient. Crit Care Med. 2023 Oct;51(10):1411-1430. doi: 10.1097/CCM.0000000000006000.

Effect of Bougie Versus Endotracheal Tube With Stylet on Successful Tracheal Intubation

Tracheal intubation is a high-risk procedure that is frequently performed in the emergency department and intensive care unit. Failure of first-pass success (FPS) when intubating has been shown to be associated with major adverse events, so maximizing FPS is paramount for improving patient outcomes. This Concise Critical Appraisal explores a study published in JAMA that sought to determine the effect of using a bougie (tracheal tube introducer) versus an endotracheal tube with stylet when intubating.

If an intubated patient worsens, how would you code a patient in the prone position? When would you consider escalating to venovenous extracorporeal membrane oxygenation in the current COVID-19 environment?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 8, 2021

What are your insights as to whether patients should be intubated early or late?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on August 11, 2021

What strategies do you use to prevent intubation?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on July 14, 2021

Early Intubation and Increased Coronavirus Disease 2019 Mortality: A Propensity Score–Matched Retrospective Cohort Study

From Critical Care Explorations. In this observational study, the authors found that iwithin 48 hours of triage, as well as at any time point in the hospital course, was associated with increased mortality in coronavirus disease 2019 patients.

Should BiPAP be used in patients with COVID-19 or should it be avoided? If you decide to intubate a patient, which parameters should be used and what initial ventilatory settings do you recommend?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 12th, 2021

Can you discuss ventilator management for the novice clinician and the optimal time for intubation in  COVID-19 patients?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on April 14th, 2021

How is it determined whether early intubation is a good strategy for a patient?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on April 14th, 2021

Which markers or patient features would cause you to choose noninvasive or high-flow nasal cannula over intubation for early management of COVID-19 respiratory failure?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on March 10, 2021

Letter to the Editor: Unclear Benefit of Early Tracheostomy In Patients With Coronavirus Disease 2019

From Critical Care Medicine. This online letter to the editor was written in response to Early Percutaneous Tracheostomy In Coronavirus Disease 2019: Association With Hospital Mortality and Factors Associated With Removal of Tracheostomy Tube at ICU Discharge. A Cohort Study on 121 Patients" by Rosano et al.

Online Letter to the Editor: Early Percutaneous Tracheostomy in the Coronavirus Disease 2019 Era: Shining New Light on Old Questions

From Critical Care Medicine. In this Online Letter to the Editor, the authors comment on an article by Rosano et al. in which it was demonstrated that early tracheostomy can be performed with acceptable safety in the midst of a pandemic and note that the study raises important questions related to the downsides of routinely performing tracheostomy, tailoring timing of tracheostomy and optimal protocols for decannulation.

In a patient who has COVID-19 respiratory infection and requires intubation, when should the patient be intubated and what is the intubation process?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021

Once a patient is intubated and on mechanical ventilation, how do you keep the patient sedated appropriately without reaching extremely high doses of sedatives and narcotics?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on January 13, 2021.

Once you intubate a patient for COVID-19, what is your starting ventilation strategy?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on January 13, 2021.

How often do you prone nonintubated patients? Are most patients on high-flow or noninvasive support being proned? What schedule is being used to alternate between prone and supine positions? Does the same schedule apply to intubated patients?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on January 13, 2021.

For patients who fail to adequately oxygenate with less invasive methods, what are your triggers for starting mechanical ventilation? What would you want the non-ICU clinician to know before going down that path? When do you decide to intubate someone?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on December 9, 2020.

What is a general go-to ventilator setting? Once you have intubated the patient, how would you recommend that the clinician set up the ventilator for a hypoxemic patient with evolving ARDS?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on December 9, 2020.

High-Flow Nasal Cannula (HFNC) Use in COVID-19 Respiratory Failure

This presentation is an overview of HFNC use for COVID-19 patients. This is SCCM curated COVID-19 microlearning content.

What is your experience with COVID-19 patients and ECMO?

Despite remdesivir, dexamethasone, and twice-daily anticoagulation, a patient’s condition continues to deteriorate. The patient is intubated, and every possible ventilation mode has been tried. The P/F ratio is decreasing, and pressure ventilation is not working. What is your experience with COVID-19 patients and ECMO? This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

How would a nonintensivist manage a patient who needs high-flow oxygen or noninvasive ventilation but does not require immediate intubation who is admitted to the ward because no ICU beds are available?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

Would you discuss the concept of happy hypoxia, in which patients have a very low saturation rate? What does this mean to emergency department physicians, hospitalists, and nurses? Should we intubate these patients as soon as we see them in the emergency

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

What is your center’s approach to supporting another center if it has a COVID-19 patient who may need intubation? What advice do you have for smaller centers that may have a potential COVID-19 patient who needs ventilation?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on October 14, 2020.

Intubated and Nonintubated Patients: Which COVID-19-Positive Patients Should be Treated With Corticosteroids?

Steve Pastores, MD, co-author of the Critical Care Explorations article "Rationale for Prolonged Corticosteroid Treatment in the Acute Respiratory Distress Syndrome Caused by Coronavirus Disease 2019," answers question regarding the use of corticosteriod treatment for ARDS caused by COVID-19. This is SCCM curated COVID-19 microlearning content.

Initial Management of Hypoxic COVID-19 Patients

COVID-19 SSC Guidelines Infographic. This rapid resource is aligned with the SSC COVID-19 Guidelines.

SCCM-ASA Joint Statement to Address the COVID-19 Pandemic

COVID-19 - SCCM Joint Statement. The Society of Critical Care Medicine (SCCM) and the American Society of Anesthesiologists (ASA) announce their plans to collaborate to address the COVID-19 crisis.

Because patients with COVID-19 seem to remain intubated for long periods of time, do you have any recommendations regarding early versus late tracheostomy?

It seems COVID-19 patients remain intubated for a long period of time. Do you have any recommendations for early vs. late tracheostomy?

Do you have any comments on airway management, instrumentation, or intubation protocols?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered.

What are your thoughts about using glucocorticoids in patients with severe ARDS secondary to COVID-19 who remain intubated after 7 days?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered.