A comparison of emergency airway management between neuromuscular blockades alone and rapid sequence intubation: an analysis of multicenter prospective study

Abstract

BackgroundAlthough airway management with neuromuscular blockade (NMB) alone is discouraged in the emergency department (ED), our previous study demonstrated that many patients were intubated using NMBs alone without sedatives. To refute this practice, we sought to compare the intubation success and adverse event rates between NMBs only and rapid sequence intubation (RSI).MethodsThis is a secondary analysis of the data from a prospective observational study of ED patients in 13 hospitals who underwent emergency airway management from April 2010 to August 2012. The primary outcome was intubation success rate on first attempt. The secondary outcomes were the intubation success rate in ≤2 attempts and the intubation-related adverse event rate. We compared these outcomes between intubation attempts using NMB alone and RSI. We fit multivariable logistic regression models adjusting for potential confounders (age, sex, weight, primary indication for intubation, and training level of intubators).ResultsOverall, 852 patients were eligible for this analysis, with 114 (13%) intubated with NMB alone and 738 (87%) with RSI. Between the NMB-alone and RSI groups, no significant differences were observed in the success rate on the first attempt (70 vs. 73%; P = 0.48) or in ≤2 attempts (89 vs. 91%; P = 0.46), or in the adverse event rate (11 vs. 12%; P = 0.58). Similarly, after adjusting for confounders, no significant differences were observed in any of these outcomes (all P > 0.05).ConclusionsIn this analysis of data from a large multicenter study of ED patients, we found no superior effectiveness of intubation with NMB alone when compared to RSI. Our data lend significant support to the concept that intubation with NMB alone should be avoided in the ED.

Pattern of antibiotics use, incidence and predictors of surgical site infections in a Tertiary Care Teaching Hospital

“…In this study, majority of patients who underwent surgical procedures received antimicrobial prophylaxis which is in line with another study [ 12 ]. However, proper AMP practice in this setup was not parallel with recommendations of the clinical practice guideline for antimicrobial prophylaxis in surgery [ 14 , 15 ].…”

“…In our study, only 37.8% of patients received preoperative antibiotics within 1 h prior to incision which is in agreement with Brazilian study [ 16 ]. However, AMP administration time is not recorded in 17 (18.9%) patients may be due to work overload on attending nurses, the absence of separate sheet for recording time of administration and lack of awareness to record AMP administration time which is consistent with other studies [ 12 ].…”

“…Another well-documented approach is to use pre and postoperative antimicrobial prophylaxis. From patients that received antimicrobial prophylaxis 30–90% are inappropriate; most antimicrobials are either given at the wrong time, wrong dosage and wrong strength which results in increased antibiotic usage, increased costs, prolonged hospitalization, super infection, antimicrobial resistance and reduction of surgical antimicrobial prophylaxis (SAP) used [ 12 , 13 ].…”

Albuminuria in patients with chronic obstructive pulmonary disease: a cross-sectional study in an African patient cohort

“…CYBOW 12MAC reagent strips are both qualitative and semi-quantitative dip strips [ 11 ]. The earlier product of the strips (CYBOW 2MAC) has been used in some studies to assess for urinary albumin [ 12 ]. The sensitivity of this test ranged from 10 mg/L to150mg/L for microalbumin and 0.9 to 26.5 mmol/L for urine creatinine.…”

Advancing emergency airway management practice and research

“…Over the past decade, the NEAR group has also made a substantial impact on the international emergency medicine research community, including the KEAMR and JEAN groups . For example, the JEAN study is a multicenter prospective effort that is run by the Japanese Emergency Medicine Network (JEMNet) (http://jemnet.asia/wp/).…”