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Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill

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Journal Club Summary
 Methodology Score: 2.5/5       Usefulness Score:  3/5
Semler MW, et al. Am J Respir Crit Care Med.2015 Oct 1. [Epub ahead of print] Abstract Link
This randomized, open-label, pragmatic trial of 150 adults undergoing intubation in a medical ICU found that the median lowest arterial oxygen saturation was 92% with apneic oxygenation versus 90% with usual care (95% confidence interval for the difference -1.6% to 7.4%; P = .16). Unfortunately, the first RCT of apneic oxygenation versus usual care outside the operating room was underpowered for a clinically important outcome; the results of this small single centre trial should not impact the use of a cheap, low risk intervention that may yet have benefit in critically ill patients.   By: Dr. Nicholas Costain
Epi lessonIntention-to-treat (ITT) Analyses Intention-to-treat (ITT) analyses are widely recommended as the preferred approach to the analysis of most clinical trials. The basic intention-to-treat principle is that partici…
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Post intubation analgesia and sedation in the ED

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You deftly sweep the tongue aside, slide into the vallecula, lift the epiglottis, and have a great view of the cords. You smoothly pass the tube, secure it, and walk away – a superstar. Meanwhile your nurses wonder “what now?” as your patient begins to wake up pulls their ET tube out.
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A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial

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Methodology Score: 2/5                 Usefulness Score: 3.5/5
Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M.Am J Emerg Med. 2013 Sep;31(9):1389-92
Abstract Link
This single centre, ED based, parallel group randomized control trial found that the topical application of an injectable form of tranexamic acid (TXA) was better than anterior nasal packing (ANP) for halting bleeding within the first 10 minutes (ARR=40%, P=<0.001) and discharging the patient from the department within the first 2 hours (ARR=89%,P=<0.001). The DEM journal club identified several errors in the paper which compromised the validity of the results; however, the overall cost effectiveness (500mg TXA at The Ottawa Hospital = $5.90) and the potential for significantly decreasing patient discomfort made this low-risk intervention very appealing to attendees.  By:Dr. Nicholas Costain (Presented January 2014)

Epi lesson: p values in baseline characteristic tables

Whether or not to present p values in Tab…
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Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration

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Laryngeal View During Laryngoscopy: A Randomized Trial Comparing Cricoid Pressure, Backward-Upward-Rightward Pressure, and Bimanual Laryngoscopy

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Landmark Series
Levitan RM, Kinkle WC, Levin WJ, Everett WW. Ann Emerg Med. 2006 Jun.;47(6):548–55.
PubMed Link

This U.S. study evaluated manipulation techniques for direct laryngoscopy during endotracheal intubation in 1,530 comparisons performed by 104 physicians in fresh cadavers. Bimanual laryngoscopy improved laryngeal view compared to cricoid pressure, backward-upward-rightward pressure, and no manipulation. JC attendees expressed considerable support for the technique of bimanual laryngoscopy where the laryngeal view was unsatisfactory.
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