When someone is critically ill and needs a breathing machine, doctors commonly choose between ketamine and etomidate to put them to sleep. Which is better? We are excited to finally share the results of the RSI trial! @UABNews @PCCRG @UABPulmonary

🔬@UABPulmonary Drs. @SGandotraMD, @DerekRussellMD David Page, and Micah Whitson report in @NEJM that preoxygenation with noninvasive ventilation, as opposed to O2 mask, results in lower incidence of hypoxemia in adults undergoing tracheal intubation. 📕loom.ly/ZisAp9Y

EMCrit 377 - Breaking News - The PREOXI Trial changes everything for Preoxygenation in Intubations in the Critically Ill! I interview the lead authors and give my RECs. [#FOAMed] I've been advocating for this for years and now we have a beautiful trial... emcrit.org/377

Since @CritCareReviews and #CCR24 have had a couple of win ratio analyses, here’s a little plug for a video I made with @CMichaelGibson a few years back that is meant to be an accessible explainer of how it works. Please excuse my hair. It was a different time.

RT is VERY busy during RSI of critically ill adults... is it worthwhile to routinely ask them to also get a mask for NIPPV during preoxygenation? Prior smaller studies suggested NIV preox might safely reduce hypoxemia, but data mixed/inconclusive. Excited for PREOXI trial!

What is the PREOXI study? Our methods 🔬 are hot 🔥 off the press 📃. In the DoD-funded PRagmatic trial Examining OXygenation prior to Intibation (PREOXI), patients undergoing emergency intubation will be randomized to a standardized NRB mask versus a pressure mask (CPAP, BPAP) for preoxygenation. Keep your eyes peeled this spring as we will answer this best-practices question. sciencedirect.com/science/ar… #emergency #emergencymedicine #icu #criticalcare #airway #ems #ambulance #sick #trauma #medic #combat #combatmedic #military #army #navy #airforce #foamed #foamcc #science #research #data #armyemdoc #medtwitter #medx

Miss the @PCCRG DEVICE trial, presented by Matthew Semler & Matthew Prekker at the Critical Care Reviews Meeting #CCR23 last week? It was simultaneously published in @NEJM doi.org/10.1056/NEJMoa230160… Here, the trialists briefly explain the results

The results from our DEVICE trial are out in the @NEJM . In this RCT, direct laryngoscopy was inferior to video laryngoscopy for first-pass success. In fact, it was so inferior that we had to stop the trial early after DSMB review due to the clear benefit of VL. This is the 🔨 nail in the ⚰️ for DL. While it's an important skill, VL should be the standard when it's available. If it's not available, we need to make it available. nejm.org/doi/full/10.1056/NE… #emergency #emergencymedicine #icu #criticalcare #airway #military #war #trauma #data #science #research #armyemdoc #medtwitter #foamcc #foamed

The model varies by site. @HennepinEM has a pretty amazing system with all sorts of support (@brian_driver?). But key to this and our other trials has been to train and truly integrate trial procedures and roles into clinical care processes.

#CCR23: In the DEVICE trial, the use of video laryngoscopy in critically ill patients undergoing intubation in the ED or ICU resulted in a higher incidence of successful intubation on the first attempt than direct laryngoscopy. nej.md/43H2t79

Lots of great discussion at CCR23 @CritCareReviews about the trial, results, clinical implications, & future areas for research. The trial really opens question of whether VL should be the standard for all emergent intubations in the ED/ICU. Thanks for joining us, Matt Prekker.

Coming up in a few minutes, Matt Prekker and Matt Semler present the #DEVICEtrial at #CCR23. The ⁦@PCCRG⁩ conducted the largest randomized trial of video vs direct laryngoscopy in critically ill adults. Answer to this question in a few minutes criticalcarereviews.com/

It was a blast! Hope that it was helpful to everyone.

In this Friday's PCT Grand Rounds, Matthew Semler of @VUMCLHS will present a cluster-crossover trial of oxygen saturation targets for critically ill patients receiving mechanical ventilation. Join us! #pctGR bit.ly/3Nh3o98