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Crit Care 2022 05 6;26(1):124. Epub 2022 May 6.

Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.

Background: Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation.

Methods: A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Read More

Pediatrics 2022 May 5. Epub 2022 May 5.

Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Rio de Janeiro, Brazil.

Background And Objectives: The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country.

Methods: Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. Read More

BMC Pediatr 2022 04 12;22(1):200. Epub 2022 Apr 12.

Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.

Background: Bronchopulmonary dysplasia (BPD) is one of the most common adverse consequence of premature delivery and the most common chronic lung disease in infants. BPD is associated with long-term lung diseases and neurodevelopmental disorders that can persist into the adulthood. The adverse consequences caused by severe BPD are more serious. Read More

Front Med (Lausanne) 2022 25;9:813833. Epub 2022 Feb 25.

State Key Laboratory of Complex Severe and Rare Diseases, Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Background: Tracheal intubation is a necessary but risky procedure performed in emergency departments (EDs) around the world. Relatively high morbidity has been encountered in Chinese EDs, which has raised concerns about peri-intubation ED management. This study aimed to investigate intubation procedures and identify any areas for improvement in Chinese EDs. Read More

Neonatal Netw 2022 Mar;41(2):107-113

Resuscitations in the delivery room or the nursery cause significant stress for caregivers. Diligent preparation will improve the efficacy and safety of life-saving interventions and increase staff comfort. When establishment of an airway and delivery of positive pressure ventilation and chest compressions fail to result in return of spontaneous circulation, pharmacotherapeutic interventions should be considered. Read More

Transl Psychiatry 2022 03 3;12(1):90. Epub 2022 Mar 3.

AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France.

The acid sphingomyelinase (ASM)/ceramide system may provide a useful framework for better understanding SARS-CoV-2 infection and the repurposing of psychotropic medications functionally inhibiting the acid sphingomyelinase/ceramide system (named FIASMA psychotropic medications) against COVID-19. We examined the potential usefulness of FIASMA psychotropic medications in patients with psychiatric disorders hospitalized for severe COVID-19, in an observational multicenter study conducted at Greater Paris University hospitals. Of 545 adult inpatients, 164 (30. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022 Feb;36(2):142-144

This paper reports a case of acquired laryngosis stenosis treated by arc plasma ablation, drug stent implantation and balloon dilatation. The patient with difficulty in pulling out the tube after intubation 3 years ago was diagnosed with laryngotracheal stenosis and treated with tracheotomy, in order to extubation. Physical examination showed that the metal trachea cannula in front of the neck was in position, unobstructed, and can be seen slightly inspiratory three concave sign when moving. Read More

Life Sci 2022 Apr 30;294:120368. Epub 2022 Jan 30.

Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX 78229, USA.

The fear of SARS-CoV-2 infection is due to its high mortality related to seasonal flu. To date, few medicines have been developed to significantly reduce the mortality of the severe COVID-19 patients, especially those requiring tracheal intubation. The severity and mortality of SARS-CoV-2 infection not only depend on the viral virulence, but are primarily determined by the cytokine storm and the destructive inflammation driven by the host immune reaction. Read More

J Emerg Med 2022 02 12;62(2):163-170. Epub 2022 Jan 12.

Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Flight For Life, Waukesha, Wisconsin.

Background: Rapid sequence intubation (RSI) is performed by helicopter emergency medical services (HEMS) providers to establish airway control. Common induction agents are etomidate and ketamine, both touted to have relatively stable hemodynamic profiles. Limited data comparing these medications in the air medical setting exist. Read More

Medicine (Baltimore) 2022 Jan;101(1):e28482

Intensive Care Unit, Hebei General Hospital, Shijiazhuang City, Hebei Province, PR China.

Introduction: Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts. It is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Compared with HIV-PJP, non-HIV PJP is more likely to develop rapidly into respiratory failure, with difficult diagnosis and high mortality. Read More

Prehosp Emerg Care 2022 ;26(sup1):42-53

Airway management is a critical intervention for patients with airway compromise, respiratory failure, and cardiac arrest. Many EMS agencies use drug-assisted airway management (DAAM) - the administration of sedatives alone or in combination with neuromuscular blockers - to facilitate advanced airway placement in patients with airway compromise or impending respiratory failure who also have altered mental status, agitation, or intact protective airway reflexes. While DAAM provides several benefits including improving laryngoscopy and making insertion of endotracheal tubes and supraglottic airways easier, DAAM also carries important risks. Read More

Prehosp Emerg Care 2022 ;26(sup1):72-79

Airway management is a critical component of resuscitation but also carries the potential to disrupt perfusion, oxygenation, and ventilation as a consequence of airway insertion efforts, the use of medications, and the conversion to positive-pressure ventilation. NAEMSP recommends:Airway management should be approached as an organized system of care, incorporating principles of teamwork and operational awareness.EMS clinicians should prevent or correct hypoxemia and hypotension prior to advanced airway insertion attempts. Read More

Respirology 2022 02 30;27(2):109-111. Epub 2021 Dec 30.

Perth USAsia Centre, The University of Western Australia, Perth, Western Australia, Australia.

Acta Anaesthesiol Scand 2022 Apr 11;66(4):463-472. Epub 2022 Jan 11.

Finnish Meteorological Institute, Helsinki, Finland.

Background: Intubation, laryngoscopy, and extubation are considered highly aerosol-generating procedures, and additional safety protocols are used during COVID-19 pandemic in these procedures. However, previous studies are mainly experimental and have neither analyzed staff exposure to aerosol generation in the real-life operating room environment nor compared the exposure to aerosol concentrations generated during normal patient care. To assess operational staff exposure to potentially infectious particle generation during general anesthesia, we measured particle concentration and size distribution with patients undergoing surgery with Optical Particle Sizer. Read More

J Thorac Cardiovasc Surg 2021 Nov 24. Epub 2021 Nov 24.

Tsui Laboratory, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa; Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pa. Electronic address:

Objectives: To develop and evaluate a high-dimensional, data-driven model to identify patients at high risk of clinical deterioration from routinely collected electronic health record (EHR) data.

Materials And Methods: In this single-center, retrospective cohort study, 488 patients with single-ventricle and shunt-dependent congenital heart disease <6 months old were admitted to the cardiac intensive care unit before stage 2 palliation between 2014 and 2019. Using machine-learning techniques, we developed the Intensive care Warning Index (I-WIN), which systematically assessed 1028 regularly collected EHR variables (vital signs, medications, laboratory tests, and diagnoses) to identify patients in the cardiac intensive care unit at elevated risk of clinical deterioration. Read More

Air Med J 2021 Nov-Dec;40(6):385-389. Epub 2021 Sep 20.

Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.

Objective: Airway management to ensure sufficient gas exchange is of major importance in emergency care. Prehospital endotracheal intubation (ETI) by paramedics is a widely debated method to ensure a patent airway. ETI is performed with procedural sedation in comatose patients because of the regulation. Read More

Stud Health Technol Inform 2021 Nov;286:84-88

Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.

Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. However, only a few studies have examined the impact of these aerosol boxes on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. In addition, to our knowledge, only a few studies have included in the concerned testbeds elements of the work context, which nevertheless have an impact on the use of the device. Read More

Anesth Prog 2021 10;68(3):141-145

Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry, Tokyo, Japan.

Objective: Antipsychotic drugs exhibit α-1 adrenergic receptor-blocking activity. When epinephrine and antipsychotic drugs are administered in combination, β-2 adrenergic effects are thought to predominate and induce hypotension. This study aimed to assess hemodynamic parameters in patients regularly taking antipsychotics who were administered epinephrine-containing lidocaine under general anesthesia in a dental setting. Read More

Int J Pediatr Otorhinolaryngol 2021 Dec 30;151:110933. Epub 2021 Sep 30.

ENT Department, Great Ormond Street Hospital for Children, London, UK.

Introduction: Use of self-expanding foam-filled tracheostomy tube cuffs (Bivona® FOME cuf®) in paediatrics has become a recent practice within our institution for patients with intractable aspiration. The current literature, clinical indications and subsequent management is lacking. We present our experience with a cohort of children with a foam-cuffed tracheostomy tube managed at Great Ormond Street Hospital, describing their indications and outcomes, as well as routine and emergency management. Read More

Air Med J 2021 Sep-Oct;40(5):312-316. Epub 2021 Jul 2.

Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC.

Objective: Rapid sequence intubation (RSI) is often required in managing critically ill patients in the prehospital setting. Although etomidate is a commonly used induction agent for RSI, ketamine has gained new interest in prehospital management with reported neutral hemodynamic effects. Limited data exist to support ketamine as an alternative to etomidate, particularly in the prehospital setting. Read More

J Emerg Med 2021 12 9;61(6):695-704. Epub 2021 Sep 9.

Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.

Background: The aerosol box and intubation tent are improvised barrier-enclosure devices developed during the novel coronavirus pandemic to protect health care workers from aerosol transmission.

Objective: Using time to intubation as a crude proxy, we aimed to compare the efficiency and usability of the aerosol box and intubation tent in a simulated manikin.

Methods: This was a single-center, randomized, crossover manikin study involving 28 participants (9 anesthetists, 16 emergency physicians, and 3 intensivists). Read More

Anaesthesia 2022 02 25;77(2):230-231. Epub 2021 Aug 25.

University of Bristol, Bristol, UK.

J Vis Exp 2021 08 4(174). Epub 2021 Aug 4.

Department of Pediatrics, Case Western Reserve University;

Treatment of neonatal rodent with drugs instilled directly into the trachea could serve as a valuable tool to study the impact of a locally administered drug. This has direct translational impact because surfactant and drugs are administered locally into the lungs. Though the literature has many publications describing minimally invasive transoral intubation of adult mice and rats in therapeutic experiments, this approach in neonatal rat pups is lacking. Read More

Ann Emerg Med 2021 12 18;78(6):708-719. Epub 2021 Aug 18.

Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA.

Study Objective: We sought to (1) characterize emergency department (ED) intubations in trauma patients and estimate (2) first-pass success and (3) the association between patient and intubation characteristics and first-pass success.

Methods: We performed a secondary analysis of a multicenter prospective observational cohort of ED intubations from the National Emergency Airway Registry (NEAR). Descriptive statistics were calculated for all patients who were intubated for trauma at 23 NEAR EDs between 2016 and 2018. Read More

Anesth Analg 2021 09;133(3):648-662

Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Emergency airway management outside the operating room (OR) is often associated with an increased risk of airway related, as well as cardiopulmonary, complications which can impact morbidity and mortality. These emergent airways may take place in the intensive care unit (ICU), where patients are critically ill with minimal physiological reserve, or other areas of the hospital where advanced equipment and personnel are often unavailable. As such, emergency airway management outside the OR requires expertise at manipulation of not only the anatomically difficult airway but also the physiologically and situationally difficult airway. Read More

J Aerosol Med Pulm Drug Deliv 2021 08 21;34(4):262-264. Epub 2021 Jun 21.

Department of Anesthesia and Critical Care, and Spedali Riuniti Livorno Estav Nordovest, Livorno, Italy.

Despite the various parenchymal presentation of coronavirus disease 2019 (COVID-19) pneumonia, the involvement of the vascular component, the reduction of perfusion in noninjured part of the lung and secondary right to left shunt play an important role in the genesis of the respiratory insufficiency. We present the case of a 72-year-old woman admitted to Livorno Hospital for severe respiratory insufficiency due to SARS-CoV-2 infection unresponsive to noninvasive in whom administration of nebulized phosphodiesterase 3 (PDE3) inhibitor enoximone was able to improve oxygenation avoiding tracheal intubation. Intravenous infusions of phosphodiesterase inhibitors are commonly used as pulmonary vasodilators in the management of pulmonary hypertension. Read More

Minerva Anestesiol 2021 12 16;87(12):1381-1382. Epub 2021 Jun 16.

Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.

Emerg Med Australas 2021 08 2;33(4):728-733. Epub 2021 Jun 2.

National Trauma Research Institute, Melbourne, Victoria, Australia.

Objective: In response to COVID-19, we introduced and examined the effect of a raft of modifications to standard practice on adverse events and first-attempt success (FAS) associated with ED intubation.

Methods: An analysis of prospectively collected registry data of all ED intubations over a 3-year period at an Australian Major Trauma Centre. During the first 6 months of the COVID-19 pandemic in Australia, we introduced modifications to standard practice to reduce the risk to staff including: aerosolisation reduction, comprehensive personal protective equipment for all intubations, regular low fidelity simulation with 'sign-off' for all medical and nursing staff, senior clinician laryngoscopist and the introduction of pre-drawn medications. Read More

Aust Crit Care 2021 11 26;34(6):530-538. Epub 2021 May 26.

Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia.

Background/objective: Endotracheal suction is one of the most common and harmful procuedres performed on mechanically ventilated children. The aim of the study was to establish the feasibility of a randomised controlled trial (RCT) examining the effectiveness of normal saline instillation (NSI) and a positive end-expiratory pressure recruitment manoeuvre (RM) with endotracheal suction in the paediatric intensive care unit.

Methods: Pilot 2 × 2 factorial RCT. Read More

Clin Pharmacol Ther 2021 12 2;110(6):1498-1511. Epub 2021 Jul 2.

Assistance Publique-Hopitaux de Paris, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR_S1266, Université de Paris, Paris, France.

Several medications commonly used for a number of medical conditions share a property of functional inhibition of acid sphingomyelinase (ASM), or FIASMA. Preclinical and clinical evidence suggest that the ASM/ceramide system may be central to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection. We examined the potential usefulness of FIASMA use among patients hospitalized for severe coronavirus disease 2019 (COVID-19) in an observational multicenter study conducted at Greater Paris University hospitals. Read More