Exclusion Criteria 1. Operator or supervisor feels specific intra- procedural laryngoscopy device will be required.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Exclusion Criteria 1. Operator or supervisor feels specific intra- procedural laryngoscopy device will be required."

Transcription

1 FELLOW Study Data Analysis Plan Direct Laryngoscopy vs Video Laryngoscopy Background Respiratory failure requiring endotracheal intubation occurs in as many as 40% of critically ill patients. Procedural complications including failed attempts at intubation, esophageal intubation, arterial oxygen desaturation, aspiration, hypotension, cardiac arrest, and death are common in this setting. While there are many important components of successful airway management in critical illness, the maintenance of adequate arterial hemoglobin saturation from procedure initiation until endotracheal tube placement is paramount as desaturation is the most common factor associated with periintubation cardiac arrest and death. Interventions that either shorten the duration of time required for tube placement or prolong the period before desaturation may be effective in improving outcome. The high rate of complications and the lack of existing evidence regarding the efficacy of current airway management techniques in shortening the time to airway establishment or prolonging the time to desaturation mandates further investigation. Video laryngoscopy may increase the rate of first intubation attempt success and improve the safety of intubating critically ill patients. Patient Population Adult patients undergoing intubation in the medical intensive care unit of an academic, tertiary care hospital. Inclusion Criteria 1. Patients undergoing intubation in the Medical ICU 2. Planned operator is a pulmonary and critical care medicine fellow 3. Administration of sedation and/or neuromuscular blockade is planned Exclusion Criteria 1. Operator or supervisor feels specific intra- procedural laryngoscopy device will be required. Specific Hypothesis Video laryngoscopy will be superior to direct laryngoscopy in successful first attempt at endotracheal intubation (defined by confirmed placement of an endotracheal tube in the trachea during first laryngoscopy attempt) after controlling for the operator s past number of procedures with the equipment used. Variable Definitions Primary Outcome The primary outcome for the laryngoscopy study will be first attempt success rate (defined as the placement of an endotracheal tube in the trachea after the first insertion of the laryngoscope into the oral cavity without the use of any other devices) with video laryngoscopy compared with direct laryngoscopy. The primary analysis will be adjusted for the number of times

2 the operator has previously used the assigned laryngoscopy device at the time of the procedure. Secondary Outcomes Secondary efficacy outcomes will include: 1. Unadjusted analysis of successful first attempt of endotracheal intubation 2. Time from initiation of sedation and/or paralysis to the successful placement of an endotracheal tube in the trachea. 3. Number of attempts to successfully intubate the trachea 4. Need for second operator 5. Need for additional intubating equiptment 6. Grade of view on first attempt Secondary safety outcomes will include: 1. Incidence of hypoxemia as defined by lowest oxygen saturation less than 90% 2. Procedural Hypotension 3. Number of esophageal intubations 4. Airway trauma 5. Incidence of post- intubation tube malposition on CXR Tertiary Outcomes Tertiary outcomes will include: 1. In- hospital mortality 2. Ventilator- free days (VFDs) 3. ICU- free days Data Collection and Follow Up Baseline: Age, gender, height, weight, race, APACHE II score, active medical problems at the time of intubation, active comorbidities complicating intubation, mean arterial pressure and vasopressor use prior to intubation, noninvasive ventilator use, highest FIO2 delivered in prior 6 hours, lowest oxygen saturation in prior six hours, ph, PaO2, PaCO2, indication for intubation, reintubation, preoxygenation technique, operator experience, additional personnel available Per- procedural: Date and time of sedative and/or neuromuscular blocker administration, saturation at time of sedative and/or neuromuscular blocker administration, sedative, neuromuscular blocker, ventilation between induction and laryngoscopy, tube characteristics, route, laryngoscope type and size, total number of attempts, tube tape level, confirmation of placement technique, airway grade, airway difficulty, rescue device use, complications 0-6 hours: Post- intubation imaging, post intubation shock or cardiac arrest, SaO2, FIO2, PEEP, and MAP at 1 and 6 hours after intubation.

3 death In- Hospital Outcomes: Date of extubation, date of ICU discharge, date of Treatment Allocation Opaque randomization envelopes will be present in the medical ICU and available to PCCM fellows when it is determined endotracheal intubation will be performed. Randomization will occur in permuted blocks of four to eight and the study personnel along with the operators will be blinded to the randomization assignments prior to the opening of an envelope. Once it has been determined by the treating team that (1) intubation is required, (2) the PCCM fellow will be the first to attempt the procedure, and (3) a specific intubating device or oxygenation strategy is not indicated, the operator will open the envelope and follow the assignment of either direct laryngoscopy or video laryngoscopy for the airway management procedure. Power and Sample Size As previous observational analyses have shown that the success rate of PCCM fellows at direct laryngoscopy is 68% compared to 91% with video laryngoscopy, we will need to randomize 142 airway management events to detect a significant difference in rate of successful first attempt intubation with 90% power. Anticipating a small number of cases in which the primary endpoints may be unavailable due to the emergent circumstances surrounding the procedure, we will prospectively plan to continue the study until a total of 150 airway management events have been included. Consent As direct laryngoscopy and video laryngoscopy are both common in the current practice of endotracheal intubation of critically ill patients, and intubation is so commonly urgent that informed consent is not obtained for the majority of intubations as a part of routine care, a waiver of consent was granted for this study by the institutional review board at Vanderbilt. Statistical analysis Analysis principles Primary analysis will be conducted on an intention- to- treat basis (patients who have protocol violations are analyzed per the assigned treatment arm). All hypothesis tests will be two sided, with an α of 0.05 unless otherwise specified. All analyses are unadjusted unless otherwise specified. Subgroup analyses will be performed irrespective of treatment efficacy. Trial profile

4 We will present a Consolidated Standards of Reporting Trials diagram as Figure 1 to detail the movement of patients through the study. This diagram will include total patients screened, number who met inclusion and exclusion criteria, number enrolled and randomized in the study, number followed, and number analyzed. Baseline comparisons and assessment of randomization To assess randomization success, we will summarize in Table 1 the distribution of baseline variables across the study arms. Categorical variables will be reported as frequencies and percentages and continuous variables as either means with SDs or medians with interquartile ranges. Variables reported will include Demographics (age, gender, race, BMI, ); Indication for intubation; Reintubation status; Active illnesses at the time of intubation; Severity of Illness (APACHE II score); Active comorbidities complicating intubation (vomiting, upper GI bleeding, etc); Respiratory status pre- intubation (NIV use, lowest O2 saturation, FiO2); Airway management procedure (Preoxygenation technique, Saturation at time of induction, Induction medication, Neuromuscular blocker, Laryngoscope type, operator experience with laryngoscope type) Primary Analysis Adjusted test of treatment effect We will test the hypothesis that video laryngoscopy is superior to direct laryngoscopy by comparing the rate of first attempt success between groups after adjustment for the number of times the operator has used the assigned device at the time of intubation. The primary outcome of successful first attempt endotracheal intubation will be analyzed with logistic regression with the assigned device and previous experience with that device as the independent variables and the successful first attempt intubation as the dependent variable. All other comparisons will be considered secondary analyses. Secondary Analyses Analysis of Secondary Outcomes (1) We will test the hypothesis that video laryngoscopy results in a higher rate of successful first attempt intubation compared with direct laryngoscopy in an adjusted analysis using these categorical variables in a Fischer s exact test. (2) VL and DL will also be compared using the continuous variable of time to successful intubation using a Mann- Whitney U test. (3) VL and DL will be compared using the continuous variable of number of attempts to achieve successful intubation using a Mann- Whitney U test. (4) VL and DL will be compared in regards to the need for a second operator to achieve endotracheal intubation using these categorical variables in a Fischer s exact test. (5) We will test the impact of VL and DL on the following safety outcomes by comparing the following endpoints between the two randomized groups using the respective statistical methods: Grade of view on first attempt (Mann- Whitney U

5 test), Incidence of need for additional intubating equipment (Fischer s exact test), incidence of non- hypoxia complications composite of all other recorded complications (Fisher s exact test), incidence of post- intubation tube malposition on CXR (Fisher s exact test) Analysis of Tertiary Outcomes We will assess the impact of VL versus DL on in- hospital mortality using Fisher exact testing. We will assess the impact of VL versus DL on VFDs and ICU- free days using Mann- Whitney U testing. Subgroup Analyses We will repeat the intention- to- treat comparison of patients randomized to video laryngoscopy compared with direct laryngoscopy with respect to the outcome of successful first attempt intubation using the Fisher Exact test in the following subgroups: Subgroups available at procedure initiation 1. BMI No paralysis received 3. Operator experience < 10 previous uses of the device Subgroups related to procedural performance 1. Apneic oxygenation received 2. Grade III- IV view 3. Moderate or difficult airway 4. Duration of airway management above the median 5. Number of attempts required for endotracheal tube placement Modeling to Examine Potential Confounding Factors We will fit a logistic regression model for the primary outcome of successful first attempt intubation in which the variable of randomized group assignment (VL versus DL) will be accompanied by potential baseline confounders including age, BMI, APACHE II score, shock, and operator experience. Modeling to Examine Potential Interactions We will fit a logistic regression model with the above covariates and will sequentially add an interaction term between randomized study group (VL versus DL) and each of the subgrouping variables defined above. Missing Data The design of the study will not produce any missing data in regards to the successful first attempt at endotracheal intubation. Conclusion

6 We describe, before any data unblinding, our approach to analyzing the data from the FELLOW study. We anticipate that this pre- specified framework will enhance the utility of the reported result and allow readers to better judge the impact.

Facilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Care Unit (FELLOW)

Facilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Care Unit (FELLOW) Facilitating EndotracheaL Intubation by Laryngoscopy technique and Apneic Oxygenation Within the Intensive Data Analysis Plan: Apneic Oxygenation vs. No Apneic Oxygenation Background Critically ill patients

More information

All bedside percutaneously placed tracheostomies

All bedside percutaneously placed tracheostomies Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy

More information

Early-goal-directed therapy and protocolised treatment in septic shock

Early-goal-directed therapy and protocolised treatment in septic shock CAT reviews Early-goal-directed therapy and protocolised treatment in septic shock Journal of the Intensive Care Society 2015, Vol. 16(2) 164 168! The Intensive Care Society 2014 Reprints and permissions:

More information

Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017

Capnography: The Most Vital of Vital Signs. Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Capnography: The Most Vital of Vital Signs Tom Ahrens, PhD, RN, FAAN Research Scientist, Barnes-Jewish Hospital, St. Louis, MO May, 2017 Assessing Ventilation and Blood Flow with Capnography Capnography

More information

Oxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators

Oxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators Oxygenation Failure Increase FiO2 Titrate end-expiratory pressure Adjust duty cycle to increase MAP Patient Positioning Inhaled Vasodilators Extracorporeal Circulation ARDS Radiology Increasing Intensity

More information

What is the next best step?

What is the next best step? Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female

More information

The Association Between Oxygenation Thresholds and Mortality During Extracorporeal Life Support

The Association Between Oxygenation Thresholds and Mortality During Extracorporeal Life Support The Association Between Oxygenation Thresholds and Mortality During Extracorporeal Life Support Laveena Munshi, MD, MSc November 1, 2016 Critical Care Canada Forum Interdepartmental Division of Critical

More information

Emergency Department/Trauma Adult Airway Management Protocol

Emergency Department/Trauma Adult Airway Management Protocol Emergency Department/Trauma Adult Airway Management Protocol Purpose: A standardized protocol for management of the airway in the setting of trauma in an academic center, with the goal of maximizing successful

More information

High Flow Oxygen Therapy in Acute Respiratory Failure. Laurent Brochard Toronto

High Flow Oxygen Therapy in Acute Respiratory Failure. Laurent Brochard Toronto High Flow Oxygen Therapy in Acute Respiratory Failure Laurent Brochard Toronto Conflicts of interest Our clinical research laboratory has received research grants for clinical research projects from the

More information

TRACHEOSTOMY EMERGENCIES

TRACHEOSTOMY EMERGENCIES TRACHEOSTOMY EMERGENCIES MODULE: AIRWAY TARGET: ALL ANAESTHETISTS, INTENSIVISTS, ED & ACUTE PHYSICIANS, FOUNDATION DOCTORS BACKGROUND: Around 16% of ICU patients may have a tracheostomy. Life- threatening

More information

Surgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09

Surgery Grand Rounds. Non-invasive Ventilation: A valuable tool. James Cromie, PGY 3 8/24/09 Surgery Grand Rounds Non-invasive Ventilation: A valuable tool James Cromie, PGY 3 8/24/09 History of mechanical ventilation 1930 s: use of iron lung 1940 s: First NIV system (Bellevue Hospital) 1950 s:

More information

Proposed presentation of data for ICU-ROX.

Proposed presentation of data for ICU-ROX. Proposed presentation of data for ICU-ROX. Version 1 was posted online on 21 November 2017 (prior to the interim analysis which occurred when the 500 th participant reached day 28). This version (version

More information

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with

More information

LAS VEGAS Case Report Form 1 Intra-Operative

LAS VEGAS Case Report Form 1 Intra-Operative LAS VEGAS Case Report Form 1 Intra-Operative Patient Informed Consent 1. Informed consent applicable: yes no (choose no if waived by local EC) 1.1 If applicable; was consent obtained? yes no 1.2 If yes,

More information

Rapid Sequence Induction

Rapid Sequence Induction Rapid Sequence Induction Virtual simultaneous administration, after preoxygenation, of a potent sedative agent and a rapidly acting neuromuscular blocking agent to facilitate rapid tracheal intubation

More information

DAILY SCREENING FORM

DAILY SCREENING FORM DAILY SCREENING FORM Patient s initials: Date of admission: Time of admission: Gender: M F Year of Birth: Type of admission: Medical/Surgical/Postoperative (elective) Days Date Mechanical ventilation Lung

More information

ARTICLE IN PRESS. doi: /j.jemermed TRAUMA PATIENTS CAN SAFELY BE EXTUBATED IN THE EMERGENCY DEPARTMENT

ARTICLE IN PRESS. doi: /j.jemermed TRAUMA PATIENTS CAN SAFELY BE EXTUBATED IN THE EMERGENCY DEPARTMENT doi:10.1016/j.jemermed.2009.05.033 The Journal of Emergency Medicine, Vol. xx, No. x, pp. xxx, 2009 Copyright 2009 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/09 $ see front matter

More information

Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists

Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists Original Article Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists Cenk Kirakli, Ozlem Ediboglu, Ilknur Naz, Pinar Cimen,

More information

Omiros Chalkeidis*, Georgios Kotsovolis, Apostolos Kalakonas, Maria Filippidou, Christos Triantafyllou, Dimitris Vaikos, Epaminondas Koutsioumpas

Omiros Chalkeidis*, Georgios Kotsovolis, Apostolos Kalakonas, Maria Filippidou, Christos Triantafyllou, Dimitris Vaikos, Epaminondas Koutsioumpas Acta Anaesthesiol Taiwan 2010;48(1):15 20 ORIGINAL ARTICLE A Comparison Between the Airtraq and Macintosh Laryngoscopes for Routine Airway Management by Experienced Anesthesiologists: A Randomized Clinical

More information

ADVANCED AIRWAY MANAGEMENT

ADVANCED AIRWAY MANAGEMENT The Advanced Airway Management protocol should be used on all patients requiring advanced airway management procedures. This protocol is divided into three sections the Crash Airway Algorithm, the Rapid

More information

Trial protocol - NIVAS Study

Trial protocol - NIVAS Study 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Trial protocol - NIVAS Study METHODS Study oversight The Non-Invasive Ventilation after Abdominal Surgery

More information

What s New About Proning?

What s New About Proning? 1 What s New About Proning? J. Brady Scott, MSc, RRT-ACCS, AE-C, FAARC Director of Clinical Education and Assistant Professor Department of Cardiopulmonary Sciences Division of Respiratory Care Rush University

More information

SECTION 1: INCLUSION/EXCLUSION CRITERIA INCLUSION CRITERIA Please put a cross in the Yes or No box for each question

SECTION 1: INCLUSION/EXCLUSION CRITERIA INCLUSION CRITERIA Please put a cross in the Yes or No box for each question Site Number Patient s Initials SECTION 1: INCLUSION/EXCLUSION CRITERIA INCLUSION CRITERIA Please put a cross in the Yes or No box for each question Yes No 1.1 Is the patient receiving invasive mechanical

More information

The use of proning in the management of Acute Respiratory Distress Syndrome

The use of proning in the management of Acute Respiratory Distress Syndrome Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning

More information

ASPIRATION DURING ANAESTHESIA

ASPIRATION DURING ANAESTHESIA ASPIRATION DURING ANAESTHESIA MODULE: CRITICAL INCIDENTS TARGET: ALL ANAESTHETISTS BACKGROUND: Passive regurgitation or vomiting can occur during the pre-, peri- or post- operative period risking aspiration

More information

Hospital Resource and Clinical Management Guidelines for Hospital Healthcare Providers When Routine Critical Care Resources Are Not Available

Hospital Resource and Clinical Management Guidelines for Hospital Healthcare Providers When Routine Critical Care Resources Are Not Available Hospital Resource and Clinical Management Guidelines for Hospital Healthcare Providers When Routine Critical Care Resources Are Not Available Medical College of Wisconsin Center for Medical Incident Management

More information

1.0 Abstract. Title. Keywords. Sevoflurane. Anaesthesia. Difficult to intubate (DTI) Rationale and Background

1.0 Abstract. Title. Keywords. Sevoflurane. Anaesthesia. Difficult to intubate (DTI) Rationale and Background 1.0 Abstract Title A prospective, open-label, multicenter, post marketing, observational study to investigate the effectiveness of Sevoflurane anaesthesia in difficult-to-intubate Egyptian patients. Keywords

More information

A Successful RSI Program

A Successful RSI Program RSI A Successful RSI Program Requires understanding of: Indications Contraindications Limitations Requires knowledge of: Physiology Pharmacology Airway techniques Goals of RSI Success rates comparable

More information

IFT1 Interfacility Transfer of STEMI Patients. IFT2 Interfacility Transfer of Intubated Patients. IFT3 Interfacility Transfer of Stroke Patients

IFT1 Interfacility Transfer of STEMI Patients. IFT2 Interfacility Transfer of Intubated Patients. IFT3 Interfacility Transfer of Stroke Patients IFT1 Interfacility Transfer of STEMI Patients IFT2 Interfacility Transfer of Intubated Patients IFT3 Interfacility Transfer of Stroke Patients Interfacility Transfer Guidelines IFT 1 TRANSFER INTERFACILITY

More information

ARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up?

ARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up? ARDS: The Evidence Todd M Bull MD Professor of Medicine Division of Pulmonary Sciences and Critical Care Division of Cardiology Director Pulmonary Vascular Disease Center Director Center for Lungs and

More information

DIFFICULT AIRWAY MANAGMENT. Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr)

DIFFICULT AIRWAY MANAGMENT. Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr) DIFFICULT AIRWAY MANAGMENT Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr) AIRWAY MANAGEMENT AND MAINTAINING OXYGENATION ARE THE FUNDAMENTAL RESPONSIBILITIES OF ANY BASIC DOCTOR. TO MANAGE A DIFFICULT AIRWAY,

More information

Update in Critical Care Medicine

Update in Critical Care Medicine Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update

More information

Keeping Patients Off the Vent: Bilevel, HFNC, Neither?

Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Robert Kempainen, MD Pulmonary and Critical Care Medicine Hennepin County Medical Center University of Minnesota School of Medicine Objectives Summarize

More information

Invasive mechanical ventilation is

Invasive mechanical ventilation is A randomized, controlled trial of the role of weaning predictors in clinical decision making* Maged A. Tanios, MD, MPH; Michael L. Nevins, MD; Katherine P. Hendra, MD; Pierre Cardinal, MD; Jill E. Allan,

More information

European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE. Data Collection Forms

European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE. Data Collection Forms European Society of Intensive Care Medicine (ESICM) Acute Respiratory Failure Section WEAN SAFE Data Collection Forms Study ID: Date of Data collection: FORM 0: - ORGANIZATIONAL DATA OF THE PARTICIPATING

More information

Nutrition and Sepsis

Nutrition and Sepsis Nutrition and Sepsis Todd W. Rice, MD, MSc Associate Professor of Medicine Vanderbilt University 2017 DNS Symposium June 2, 2017 Case 55 y.o. male COPD, DM, HTN, presents with pneumonia and septic shock.

More information

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor

Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.

More information

Recent Advances in Respiratory Medicine

Recent Advances in Respiratory Medicine Recent Advances in Respiratory Medicine Dr. R KUMAR Pulmonologist Non Invasive Ventilation (NIV) NIV Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive

More information

Extubation Failure & Delay in Brain-Injured Patients

Extubation Failure & Delay in Brain-Injured Patients Extubation Failure & Delay in Brain-Injured Patients Niall D. Ferguson, MD, FRCPC, MSc Director, Critical Care Medicine University Health Network & Mount Sinai Hospital Associate Professor of Medicine

More information

Etomidate is a short-acting, sedative hypnotic

Etomidate is a short-acting, sedative hypnotic Hosp Pharm 2014;49(2):177 183 2014 Thomas Land Publishers, Inc. www.hospital-pharmacy.com doi: 10.1310/hpj4902-177 Original Article Effects of Etomidate on Adrenal Suppression: A Review of Intubated Septic

More information

Disclosures Paul Walker MD PhD FRCSC

Disclosures Paul Walker MD PhD FRCSC 1 ` Disclosures Paul Walker MD PhD FRCSC CEO Spectral Medical 2001-present Inaugural Critical Care Program Director - University of Toronto Chief of Surgery - University Health Network 1991-1999 COO Toronto

More information

Advanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C

Advanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C Advanced Airway Management PRESENTED BY: JOSIAH POIRIER RN, JOHN GRUBER FP-C Advanced Airway Objectives Advanced airway management is a relatively low frequency, high risk intervention. The following education

More information

ROLE OF DEXAMETHASONE FOR PREVENTION OF POST-EXTUBATION AIRWAY OBSTRUCTION IN CRITICALLY ILL ADULT PATIENTS

ROLE OF DEXAMETHASONE FOR PREVENTION OF POST-EXTUBATION AIRWAY OBSTRUCTION IN CRITICALLY ILL ADULT PATIENTS ORIGINAL ARTICLE ROLE OF DEXAMETHASONE FOR PREVENTION OF POST-EXTUBATION AIRWAY OBSTRUCTION IN CRITICALLY ILL ADULT PATIENTS ROOHINA N. BALOCH, NASIR KHAN JAKHRANI, ASHOK LAL, NAUSHEEN MEHMOOD ABSTRACT

More information

Patient Management Code Blue in the CT Suite

Patient Management Code Blue in the CT Suite Patient Management Code Blue in the CT Suite David Stultz, MD November 28, 2001 Case Presentation A 53-year-old woman experienced acute respiratory distress during an IV contrast enhanced CT scan of the

More information

Noninvasive Ventilation: Non-COPD Applications

Noninvasive Ventilation: Non-COPD Applications Noninvasive Ventilation: Non-COPD Applications NONINVASIVE MECHANICAL VENTILATION Why Noninvasive Ventilation? Avoids upper A respiratory airway trauma system lacerations, protective hemorrhage strategy

More information

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency

More information

Citation for published version (APA): Leur, J. P. V. D. (2005). Clearance of bronchial secretions after major surgery Groningen: s.n.

Citation for published version (APA): Leur, J. P. V. D. (2005). Clearance of bronchial secretions after major surgery Groningen: s.n. University of Groningen Clearance of bronchial secretions after major surgery Leur, Johannes Peter van de IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish

More information

Part 2 of park s Ventilator and ARDS slides for syllabus

Part 2 of park s Ventilator and ARDS slides for syllabus Part 2 of park s Ventilator and ARDS slides for syllabus Early Neuromuscular Blockade Question 4 The early use of cis-atracurium in severe ARDS is: A. Contraindicated in patients with diabetes B. Associated

More information

Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure

Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Introduction This pediatric respiratory failure guideline is a supplement to ELSO s General Guidelines for all

More information

Neonatal Life Support Provider (NLSP) Certification Preparatory Materials

Neonatal Life Support Provider (NLSP) Certification Preparatory Materials Neonatal Life Support Provider (NLSP) Certification Preparatory Materials NEONATAL LIFE SUPPORT PROVIDER (NRP) CERTIFICATION TABLE OF CONTENTS NEONATAL FLOW ALGORITHM.2 INTRODUCTION 3 ANTICIPATION OF RESUSCITATION

More information

CASE PRESENTATION VV ECMO

CASE PRESENTATION VV ECMO CASE PRESENTATION VV ECMO Joshua Huelster, MD Fellow in Critical Care Medicine Department of Pulmonary and Critical Care Medicine Hennepin County Medical Center Disclosure There are no conflicts of interest

More information

Surfactant Administration

Surfactant Administration Approved by: Surfactant Administration Gail Cameron Senior Director Operations, Maternal, Neonatal & Child Health Programs Dr. Paul Byrne Medical Director, Neonatology Neonatal Policy & Procedures Manual

More information

Neuromuscular Blockade in ARDS

Neuromuscular Blockade in ARDS Neuromuscular Blockade in ARDS Maureen O. Meade, MD, FRCPC Critical care consultant, Hamilton Health Sciences Professor of Medicine, McMaster University www.oscillatetrial.com Disclosures None Possible

More information

PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert.

PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert. PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert. PROPRIETARY DRUG NAME / GENERIC DRUG NAME: Advil / Ibuprofen

More information

Permissive hypoxaemia. Mervyn Singer Bloomsbury Institute of Intensive Care Medicine University College London, UK

Permissive hypoxaemia. Mervyn Singer Bloomsbury Institute of Intensive Care Medicine University College London, UK Permissive hypoxaemia Mervyn Singer Bloomsbury Institute of Intensive Care Medicine University College London, UK Is mechanical ventilation such a good idea? ventilator-induced lung injury (short- & long-term)

More information

CURRENT TRENDS IN NON-INVASIVE VENTILATION. Disclosures. Why not invasive ventilation? Objectives. Currently available modes

CURRENT TRENDS IN NON-INVASIVE VENTILATION. Disclosures. Why not invasive ventilation? Objectives. Currently available modes CURRENT TRENDS IN NON-INVASIVE VENTILATION ----------------------------------------------------------- Karen Drinkard, RRT-NPS Neonatal Respiratory Clinical Specialist University of Washington Medical

More information

Wet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009

Wet Lungs Dry lungs Impact on Outcome in ARDS. Charlie Phillips MD Division of PCCM OHSU 2009 Wet Lungs Dry lungs Impact on Outcome in ARDS Charlie Phillips MD Division of PCCM OHSU 2009 Today s talk Pathophysiology of ARDS The case for dry Targeting EVLW Disclosures Advisor for Pulsion Medical

More information

2017 ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives

2017 ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives 2017 ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives Shock Syndromes and Sepsis, Pulmonary Disorders, Hepatic Failure/GI/Endocrine Emergencies, Supportive and

More information

High Flow Humidification Therapy, Updates.

High Flow Humidification Therapy, Updates. High Flow Humidification Therapy, Updates. Bernardo Selim, M.D. I have no relevant financial relationships to disclose. Assistant Professor, Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic What

More information

(Peripheral) Temperature and microcirculation

(Peripheral) Temperature and microcirculation (Peripheral) Temperature and microcirculation Prof. Jan Bakker MD, PhD Chair dept Intensive Care Adults jan.bakker@erasmusmc.nl www.intensivecare.me Intensive Care Med (2005) 31:1316 1326 DOI 10.1007/s00134-005-2790-2

More information

Chapter 40 Advanced Airway Management

Chapter 40 Advanced Airway Management 1 2 3 4 5 Chapter 40 Advanced Airway Management Advanced Airway Management The advanced airway management techniques discussed in this chapter are to introduce the EMT-B student to these procedures only.

More information

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview

Surviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality

More information

NIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH

NIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940

More information

Other methods for maintaining the airway (not definitive airway as still unprotected):

Other methods for maintaining the airway (not definitive airway as still unprotected): Page 56 Where anaesthetic skills and drugs are available, endotracheal intubation is the preferred method of securing a definitive airway. This technique comprises: rapid sequence induction of anaesthesia

More information

ECLS Registry Form Extracorporeal Life Support Organization (ELSO)

ECLS Registry Form Extracorporeal Life Support Organization (ELSO) ECLS Registry Form Extracorporeal Life Support Organization (ELSO) Center ID: Center name: Run No (for this patient) Unique ID: Birth Date/Time Sex: (M, F) Race: (Asian, Black, Hispanic, White, Other)

More information

Bronchoscopy SICU Protocol

Bronchoscopy SICU Protocol Bronchoscopy SICU Protocol Updated January 2013 Outline Clinical indications Considerations Preparation Bronchoscopy technique Bronchoalveolar Lavage (BAL) Post-procedure Purpose Bronchoscopy is a procedure

More information

Goal Directed Protocols

Goal Directed Protocols James R Dexter MD FACP FCCP Goal Directed Protocols Complete a Task or Achieve a Goal? James R Dexter MD FACP FCCP jamesrdexter@gmail.com Medical Director Respiratory Care, Redlands Community Hospital

More information

Simulation 3: Post-term Baby in Labor and Delivery

Simulation 3: Post-term Baby in Labor and Delivery Simulation 3: Post-term Baby in Labor and Delivery Opening Scenario (Links to Section 1) You are an evening-shift respiratory therapist in a large hospital with a level III neonatal unit. You are paged

More information

Application of Lung Protective Ventilation MUST Begin Immediately After Intubation

Application of Lung Protective Ventilation MUST Begin Immediately After Intubation Conflict of Interest Disclosure Robert M Kacmarek Managing Severe Hypoxemia!" 9-28-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts I disclose

More information

Acute Respiratory Failure. Presented by Omar AL-Rawajfah, RN, PhD

Acute Respiratory Failure. Presented by Omar AL-Rawajfah, RN, PhD Acute Respiratory Failure Presented by Omar AL-Rawajfah, RN, PhD Lecture Outlines Etiology and Pathophysiology Classification Assessment Collaborative Management ۲ Etiology and Pathophysiology Acute respiratory

More information

Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS

Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia

More information

Sepsis in 15 Minutes. Frank Stegall PGY3. Adapted from prior lectures by Dr. Romain, et al.

Sepsis in 15 Minutes. Frank Stegall PGY3. Adapted from prior lectures by Dr. Romain, et al. Sepsis in 15 Minutes Frank Stegall PGY3 Adapted from prior lectures by Dr. Romain, et al. What is Clinical Sepsis? A medical condition that is characterized by a whole body inflammatory state and the presence

More information

ASSOCIATION FOR ACADEMIC SURGERY Pre-Hospital Intubation is Associated with Increased Mortality After Traumatic Brain Injury 1

ASSOCIATION FOR ACADEMIC SURGERY Pre-Hospital Intubation is Associated with Increased Mortality After Traumatic Brain Injury 1 Journal of Surgical Research 170, e117 e121 (2011) doi:10.1016/j.jss.2011.04.005 ASSOCIATION FOR ACADEMIC SURGERY Pre-Hospital Intubation is Associated with Increased Mortality After Traumatic Brain Injury

More information

The GOLD Study. Goal of Open Lung Ventilation in Donors. Michael A. Matthay M.D. and Lorraine B. Ware, MD. Disclosures

The GOLD Study. Goal of Open Lung Ventilation in Donors. Michael A. Matthay M.D. and Lorraine B. Ware, MD. Disclosures The GOLD Study Goal of Open Lung Ventilation in Donors Michael A. Matthay M.D. and Lorraine B. Ware, MD Disclosures Research grants from the NHLBI, FDA & Industry - R37 HL51856 - R01 HL126176 - HL 110969

More information

Netherlands. 1Dept. of Intensive Care, Erasmus MC, Rotterdam, the Netherlands

Netherlands. 1Dept. of Intensive Care, Erasmus MC, Rotterdam, the Netherlands Early peripheral perfusion-guided fluid therapy in patients with septic shock Michel E. van Genderen MSc 1, Noel Engels MSc 1, Ralf J. P. van der Valk PhD 2,3, Alexandre Lima MD PhD 1, Eva Klijn MD 1,

More information

RAPID SEQUENCE INTUBATION FOR THE RURAL DOC

RAPID SEQUENCE INTUBATION FOR THE RURAL DOC Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12-14, 2018 Dr. Braam de Klerk VICTORIA BC 240 RAPID SEQUENCE INTUBATION FOR

More information

Long-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia*

Long-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia* Long-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia* Nita Khandelwal, MD, MS 1 ; Catherine L. Hough, MD, MS 2 ; Aasthaa Bansal,

More information

Airway Management. Key points. Rapid Sequence Intubation. Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway

Airway Management. Key points. Rapid Sequence Intubation. Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway Airway Management Prasha Ramanujam and Guy Shochat Department of Emergency Medicine UCSF Medical Center Key points Rapid Sequence Intubation Recognizing difficult airway Managing difficult airway Rapid

More information

Is the Airtraq optical laryngoscope effective in tracheal intubation by novice personnel?

Is the Airtraq optical laryngoscope effective in tracheal intubation by novice personnel? Clinical Research Article Korean J Anesthesiol 21 July 59(1): 17-21 DOI: 1.497/kjae.21.59.1.17 Is the Airtraq optical laryngoscope effective in tracheal intubation by novice personnel? Sang-Jin Park, Won

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. This online publication has been corrected. The corrected

More information

CLINICAL VIGNETTE 2016; 2:3

CLINICAL VIGNETTE 2016; 2:3 CLINICAL VIGNETTE 2016; 2:3 Editor-in-Chief: Olufemi E. Idowu. Neurological surgery Division, Department of Surgery, LASUCOM/LASUTH, Ikeja, Lagos, Nigeria. Copyright- Frontiers of Ikeja Surgery, 2016;

More information

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH

ARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3

More information

BiLevel Pressure Device

BiLevel Pressure Device PROCEDURE - Page 1 of 7 Purpose Scope Classes/ Goals Define indications and care settings for acute and chronic initiation of Noninvasive Positive Pressure Ventilation. Identify the role of Respiratory

More information

Disclosures. Objectives. Defining Adult Obesity. Body Mass Index vs. Central Obesity 9/6/2017

Disclosures. Objectives. Defining Adult Obesity. Body Mass Index vs. Central Obesity 9/6/2017 Disclosures Why is the Morbidly Obese Patient at Increased Risk for Perioperative Morbidity? Lisa R. Farmer, MD Associate Professor No conflicts of interests concerning the content of this presentation

More information

When to start SPN in critically ill patients? Refereeravond IC

When to start SPN in critically ill patients? Refereeravond IC When to start SPN in critically ill patients? Refereeravond IC Introduction (1) Protein/calorie malnutrition is very frequent in critically ill patients Protein/calorie malnutrition is associated with

More information

Changes in Breathing Variables During a 30-Minute Spontaneous Breathing Trial

Changes in Breathing Variables During a 30-Minute Spontaneous Breathing Trial Changes in Breathing Variables During a 30-Minute Spontaneous Breathing Trial Juan B Figueroa-Casas MD, Sean M Connery MSc, and Ricardo Montoya RRT BACKGROUND: Spontaneous breathing trials (SBTs) are increasingly

More information

Post-Anesthesia Care In the ICU

Post-Anesthesia Care In the ICU Post-Anesthesia Care In the ICU The following is based on current research and regional standards of care. At completion you will be able to identify Basic equipment needed at the bedside. Aldrete scoring

More information

Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013

Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee

More information

Polytrauma. Same stuff-different day! 9/14/2012. Managing the difficult airway in Multi-Systems Trauma. Jerry J Ryman CRT

Polytrauma. Same stuff-different day! 9/14/2012. Managing the difficult airway in Multi-Systems Trauma. Jerry J Ryman CRT Managing the difficult airway in Multi-Systems Trauma Jerry J Ryman CRT Polytrauma More than 1 organ system involved Pulmonary Circulatory Neurological Integumentary Musculo-skeletal Genito-urinary Endocrine

More information

Cystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012

Cystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012 Cystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012 INTRODUCTION PNEUMOTHORAX HEMOPTYSIS RESPIRATORY FAILURE Cystic Fibrosis Autosomal Recessive Genetically

More information

ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives

ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives ACCP/SCCM Critical Care Preparatory Review and Recertification Course Learning Objectives Module 1 Critical Care Pharmacy Evolution and Validation, Practice Standards, Training, and Professional Development,

More information

I. Subject: Therapeutic Bronchoscopy and Bronchoscope Assisted Intubation

I. Subject: Therapeutic Bronchoscopy and Bronchoscope Assisted Intubation I. Subject: Therapeutic Bronchoscopy and Bronchoscope Assisted Intubation II. Policy: Therapeutic flexible fiberoptic bronchoscopy procedures and bronchoscope assisted intubations will be performed by

More information

Blood transfusions in sepsis, the elderly and patients with TBI

Blood transfusions in sepsis, the elderly and patients with TBI Blood transfusions in sepsis, the elderly and patients with TBI Shabbir Alekar MICU, CH Baragwanath Academic Hospital & The University of the Witwatersrand CCSSA Congress 11 June 2015 Packed RBC - complications

More information

Standardize comprehensive care of the patient with severe traumatic brain injury

Standardize comprehensive care of the patient with severe traumatic brain injury Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma

More information

COMMISSION ON ACCREDITATION FOR RESPIRATORY CARE TMC DETAILED CONTENT OUTLINE COMPARISON

COMMISSION ON ACCREDITATION FOR RESPIRATORY CARE TMC DETAILED CONTENT OUTLINE COMPARISON A. Evaluate Data in the Patient Record I. PATIENT DATA EVALUATION AND RECOMMENDATIONS 1. Patient history e.g., admission data orders medications progress notes DNR status / advance directives social history

More information