Articles: intubation.
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Curr Opin Anaesthesiol · Oct 2023
ReviewComparative review of airway anesthesia and sedation methods for awake intubation.
Successful awake intubation hinges upon adequate airway anesthesia and sedation for patient comfort. This review will summarize relevant anatomy and regional anesthesia techniques to achieve airway anesthesia, and compare various airway anesthesia and sedation regimens. ⋯ Emerging evidence has indicated that nerve blocks for airway anesthesia may be superior to other methods of topicalization. Additionally, dexmedetomidine can be useful, both as monotherapy and with supplemental sedatives, to safely provide anxiolysis for the patient and increase success. However, it is crucial to note that the method of airway anesthesia and sedation regimen should be adapted to each patient and clinical situation, and knowledge of multiple techniques and sedation regimens can best equip anesthesiologists to do so.
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Review
Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit.
Endotracheal intubation for airway management is a common procedure in the ICU. Intubation may be difficult due to anatomic airway abnormalities but also due to physiologic derangements that predispose patients to cardiovascular collapse during the procedure. ⋯ To reduce the likelihood of complications, medical teams must be well versed in the general principles of intubation and be prepared to manage physiologic derangements while securing the airway. In this review, we present relevant literature on the approach to endotracheal intubation in the ICU and provide pragmatic recommendations relevant to medical teams performing intubations in patients who are physiologically unstable.
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Critical care medicine · Oct 2023
Practice GuidelineSociety of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient.
Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). ⋯ Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.
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J. Cardiothorac. Vasc. Anesth. · Oct 2023
Randomized Controlled TrialComparison of the Outcomes of Oral Versus Nasal Endotracheal Intubation in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study.
The choice of oral or nasal endotracheal intubation in children undergoing cardiac surgery is affected by several factors. This study compared the outcomes of oral versus nasal intubation in neonates and infants who underwent open cardiac surgery. ⋯ The nasal route for intubation is associated with less postoperative fentanyl consumption, earlier extubation, lower incidence of accidental extubation, and earlier full oral feeding than oral intubation. The nasal route is not associated with an increased risk of postoperative pneumonia or surgical wound infection.
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Critical care nurse · Oct 2023
Implementation of a Pressure Injury Prevention Protocol for Intensive Care Unit Patients Undergoing Prone Positioning.
Pressure injuries remain the most common hospital-acquired condition, according to the Agency for Healthcare Research and Quality. Patients hospitalized with COVID-19 are at especially high risk for pressure injuries, including those related to medical devices, because of their lower tissue tolerance, prolonged intubation, and common treatment with prone positioning. ⋯ The risk of hospital-acquired pressure injuries can be reduced with additional education and the use of appropriate products and protocols. All patients who undergo prone positioning, regardless of diagnosis, may benefit from implementation of a pressure injury prevention protocol that includes the use of dressing packets.