Articles: intubation.
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The high frequency of aerosolizing procedures in the ICU, including endotracheal intubation, places clinical staff at elevated risk of contracting the 2019 coronavirus (COVID-19). Use of an intubation checklist can reduce exposure risk and thus acts as a potential safeguard. Specific, step-by-step guidance to perform safe endotracheal intubation in the setting of COVID-19 are limited. This article outlines the development and refinement of a COVID-19 intubation checklist and operational protocol for ICU staff at a single center in the United States. ⋯ We present a checklist for use during high-risk intubations of COVID-19 patients, which serves as a pragmatic bedside tool for clinicians. The process of checklist development may also serve as a model for facilities preparing their own pandemic protocols.
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Multicenter Study
Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure.
Prone positioning of non-intubated patients with coronavirus disease (COVID-19) and hypoxemic respiratory failure may prevent intubation and improve outcomes. Nevertheless, there are limited data on its feasibility, safety, and physiologic effects. The objective of our study was to assess the tolerability and safety of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure. ⋯ In a small sample, prone positioning non-intubated COVID-19 patients with severe hypoxemia was safe; however, many patients did not tolerate prolonged durations. Although patients had improved oxygenation and respiratory rate in the prone position, many still required intubation. Future studies are required to determine methods to improve the tolerability of awake prone positioning and whether there is an impact on clinical outcomes.
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Review Meta Analysis
Improved COVID-19 Outcomes following Statin Therapy: An Updated Systematic Review and Meta-analysis.
Although vaccine rollout for COVID-19 has been effective in some countries, there is still an urgent need to reduce disease transmission and severity. We recently carried out a meta-analysis and found that pre- and in-hospital use of statins may improve COVID-19 mortality outcomes. Here, we provide an updated meta-analysis in an attempt to validate these results and increase the statistical power of these potentially important findings. ⋯ Taken together, this updated meta-analysis extends and confirms the findings of our previous study, suggesting that in-hospital statin use leads to significant reduction of all-cause mortality in COVID-19 cases. Considering these results, statin therapy during hospitalization, while indicated, should be recommended.
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Review Meta Analysis
The effect of cricoid pressure on tracheal intubation in adult patients: a systematic review and meta-analysis.
This meta-analysis aimed to assess the impact of cricoid pressure (CP) application on intubation outcomes. ⋯ The application of CP did not have a negative impact on the SFAIR or laryngoscopic view. Nevertheless, this maneuver may slightly prolong intubation time and increase the risk of postoperative hoarseness.
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Review Case Reports
Emergency department approach to gastric tube complications: A case report and review of the literature.
Nasogastric and orogastric tubes (NGT/OGT) are commonly used in emergency and critical care settings, with indications including medicinal administration, gastric decompression, and enteral feeding. Previous studies have highlighted a variety of complications associated with tube placement. These range from minor occurrences such as nose bleeds and sinusitis, to more severe cases highlighting tracheobronchial perforation, tube knotting, asphyxia, pulmonary aspiration, pneumothorax, and even intracranial insertion. ⋯ Here we present a case involving a 60-year-old male who was brought to the ED and suffered a right sided pneumothorax (PTX) following improper OGT placement. In this case, air insufflation was utilized, but was ineffective in detecting the properly placed tube; leakage of an endotracheal tube cuff served as a lead for misplacement while imaging was conducted. The purpose of this study is not only to highlight the numerous complications that are possible with NGT and OGT placement, but also to propose the use of multiple bedside tests (pH testing, CO2 detection, POCUS) as an alternative to radiographic imaging to increase sensitivity and specificity for detection of improperly placed tubes.