A Nasal Cannula Under the Noninvasive Positive Pressure Ventilation Mask?

Daniel J. Pallin, MD, MPH   A crossover trial in healthy volunteers suggests that a nasal cannula does not increase mask leaking significantly.   Research suggests that apneic oxygenation is of benefit during rapid sequence intubation (NEJM JW Emerg Med Sep 2017 and Am J Emerg Med 2017; 35:1184). Apneic oxygenation involves... Read more..

2017 Airway Article of the Year: Driver’s Flush Rate Oxygen for Emergency Airway Preoxygenation

Dr. Calvin A. Brown, III, presents four nominees for “Airway Article of the Year.” The nominated articles were chosen from among those featured in the 2017 Quarterly Airway Research Updates. Dr. Brown discusses the content and merits of... Read more..

Research Update: Preoxygenation, Cricoid Pressure, Pediatrics, and Video Laryngoscopy

Dr. Calvin A. Brown, III discusses the latest published research and its impact on clinical practice; focusing this quarter on cricoid pressure during RSI, cuffed vs. uncuffed pediatric endotracheal tubes, flush rate pre-oxygenation and first pass attempt video... Read more..

Cuffed vs. Uncuffed Tracheal Tubes for Children: Time to Let Go of Old Dogma

Daniel M. Lindberg, MD   In a randomized trial, cuffed tubes had better tidal volumes and less leakage.   Dogma suggests using uncuffed endotracheal tubes for children   These authors compared leakage, ventilation, and complications with cuffed versus uncuffed endotracheal tubes in a randomized trial of 104 children aged ≤16 years undergoing elective surgery at a... Read more..

No Clear Right Choice for Postextubation Support

Patricia Kritek, MD   High-flow oxygen was noninferior to noninvasive positive pressure ventilation for preventing reintubation.   During the last 2 years, we have seen a rapid rise in use of high-flow oxygen. Although its use is supported during the immediate postextubation period for patients at low risk for reintubation (NEJM JW... Read more..

Management of the Difficult and Failed Airway, 3rd Edition

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Cricoid Pressure During Laryngoscopy – What Is It Good For?

Ali S. Raja, MD, MBA, MPH   Absolutely nothing. A small study finds that it is biomechanically impossible to maintain adequate cricoid pressure, even with real-time monitoring using a scale.   A number of studies have called into question the practice of cricoid pressure (CP) — meant to occlude the esophagus and prevent aspiration... Read more..

Research Update: Apneic Oxygenation, Video Laryngoscopy, and Pre-hospital Airway Management

Dr. Calvin A. Brown, III is joined by special guest Dr. Jestin Carlson to discuss the latest published research.  Follow the case as they discuss apneic oxygenation, video laryngoscopy in the ICU and difficult airway prediction for prehospital... Read more..

Research Update: Video vs. Direct Laryngoscopy, ICU, and Positioning

Dr. Calvin A. Brown, III uses a case discussion to introduce the latest published airway research and discusses its impact on clinical practice in this Independence Day edition of the Airway Research Update. Read more..

Mike Steuerwald MD Appointed Associate Medical Director of First Airway

First Airway LLC, the creators of The Difficult Airway Course: EMS,  is pleased to announce the appointment of Mike Steuerwald, MD as the new Associate Medical Director.   Dr. Steuerwald is the Director of Emergency Airway Management and the Assistant Medical Director of UW Med Flight, as well as an Assistant Professor at the... Read more..

High-Flow Oxygen for Cardiogenic Pulmonary Edema? Don’t Bother

Daniel J. Pallin, MD, MPH   A decrease in respiratory rate was not accompanied by more-meaningful improvements in outcomes.   High-flow nasal cannula oxygen (HFO) therapy is an evidence-based modality for treatment of hypoxemic respiratory failure (a href="http://dx.doi.org/10.1056/NEJMoa1503326" target=_blank">N Engl J Med 2015 Jun 4; 372:2185). Now, investigators in a Thai emergency department (ED)... Read more..

Airway Industry Headlines

January 10, 2019 - Verathon Enters Single Use Bronchoscopy Market with Introduction of GlideScope® BFlex™ May 1, 2018 - Three-Year Contract Awarded to KARL STORZ by Premier Inc. for Video Laryngoscopy Products March 19, 2018 - Mercury Medical Announces New Agreement... Read more..

Apneic Oxygenation Prevents Desaturation During Intubation

Daniel J. Pallin, MD, MPH   Two meta-analyses used different methods but have similar findings.   Apneic oxygenation is the delivery of high-flow oxygen by nasal cannula during endotracheal intubation. Two separate meta-analyses provide pooled results from trials of apneic oxygenation.   The first meta-analysis included 8 studies and 1953 patients in critical care settings. It... Read more..

Video Laryngoscopy Does Not Improve First-Pass Success in ICU Patients

Richard L. Byyny, MD, MSc, FACEP   In a meta-analysis of randomized, controlled trials, rates of first-pass success and most complications were not significantly better with video laryngoscopy compared with direct laryngoscopy.   These authors performed a meta-analysis of randomized, controlled trials to evaluate the utility of video laryngoscopy (VL) versus direct laryngoscopy (DL)... Read more..

Walls Manual of Emergency Airway Management, 5th Edition

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Ramped Position Not Superior to Sniffing Position for Intubating Critical Care Patients

Richard L. Byyny, MD, MSc, FACEP   In this study of intensive care unit patients, the ramped position did not reduce rates of desaturation, and it increased the difficulty of intubation.   These authors performed a multicenter randomized trial to compare the ramped versus the sniffing position for intubating intensive care unit (ICU) patients.... Read more..

video-3-ilma-intubation

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The Difficult Airway App Version 2.1 Now Available

Airway Management Education Center is pleased to announce the release of the newest version of The Difficult Airway App™ for iPhone. The Difficult Airway App™ is an essential tool for clinicians who manage emergency airways in the Emergency Department, ICU, in-patient unit or EMS environments. This app guides users quickly and... Read more..

The Emergency Algorithms 2017

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March 2017 Quarterly Airway Management Research Update

Dr. Calvin A. Brown, III uses a case discussion to introduce the latest published airway research and discusses its impact on clinical practice. Read more..

First-Pass Intubation Success Associated with Video Laryngoscopy and RSI

Daniel M. Lindberg, MD   First-pass success increased concurrently with an increase in use of video laryngoscopy and rapid sequence intubation over a 6-year period in Japan.   Emergency endotracheal intubation is considered by many the cornerstone of emergency medicine procedural knowledge. Increased first-pass intubation success is associated with decreased rates of uncommon serious... Read more..

Lung Protective Strategy for Acute Respiratory Distress Syndrome Saves Lives

Daniel M. Lindberg, MD     Lung-protective ventilation has been shown to improve outcomes for patients with acute respiratory distress syndrome (ARDS) but compliance is poor in the emergency department (ED). After finding... Read more..

Video Laryngoscopy vs. Direct Laryngoscopy in the Intensive Care Unit

Patricia Kritek, MD   A multicenter trial showed similar first-pass intubation rates but more complications with video laryngoscopy.   As video laryngoscope (VL) use has increased in the operating room, it also has become more common in the intensive care unit (ICU). Intubations in the ICU generally are higher risk, with patients commonly hypoxemic... Read more..

Seated vs. Supine Patient Positioning for Emergency Intubation

Daniel J. Pallin, MD, MPH   First-attempt intubation success was more common with more-upright patient positioning.   Prior research has suggested that patients should be intubated emergently in an upright, head-forward position rather than in the traditional supine position (NEJM JW Emerg Med Mar 15 2016; [e-pub] and Anesth Analg 2016; 122:1101).   To... Read more..

Airway Management Outside the Operating Room: How to Better Prepare

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Do We Harm Patients by Intubating During In-Hospital Codes?

Patricia Kritek, MD   Intubation during arrest was associated with worse outcomes.   The 2015 American Heart Association Advanced Cardiovascular Life Support guidelines deemphasize advanced airway placement as a component of initial resuscitation. Out-of-hospital–arrest data suggest lower survival among patients who are intubated in the field (NEJM JW Emerg Med Feb 2013... Read more..

Perioperative Respiratory Adverse Events in Infants: LMA vs. Endotracheal Intubation

Katherine Bakes, MD   Infants who underwent endotracheal intubation had three times greater risk for perioperative respiratory adverse events than those with a laryngeal mask airway.   Investigators prospectively compared the incidence of perioperative respiratory adverse events among infants (ages 0–12 months) randomized to receive either a laryngeal mask airway (LMA) or endotracheal intubation... Read more..

Propofol Might Be Better than Midazolam for ED Procedural Sedation

Daniel J. Pallin, MD, MPH   In a retrospective cohort study, propofol was more effective than midazolam and just as safe.   Propofol and midazolam are each commonly used for procedural sedation in the emergency department (ED). To compare their efficacy and safety, investigators reviewed a convenience sample of procedural sedations performed at five... Read more..

2016 Airway Article of the Year Award Winner Announced

  Airway Management Education Center, the creators of The Difficult Airway Course™, hosted the fifth annual “Airway Article of the Year” award show as a live webinar on December 15, 2016.  Webinar host, Calvin Brown III, MD presented three articles as finalists.  The nominees were selected from among all of the... Read more..

Crank Up the Oxygen and Skip the Bag-Valve-Mask

Daniel J. Pallin, MD, MPH   High-flow oxygen through a nonrebreather mask is noninferior to bag-valve-mask for preoxygenation.   Preoxygenation is a key step in rapid sequence intubation and involves allowing the patient to breath spontaneously with supplemental oxygen. The classic method, thought to achieve the highest alveolar oxygen concentration, is to use a... Read more.. 1 2