Propofol in ICU intubations – is it safe?

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Dr Paul Mayo and Dr Seth Koenig, both who have debated Dr Scott Weingart on propofol only intubations in ICU have finally published their safety profile of this practice from their ICU.

Safety of Propofol as an Induction Agent for Urgent Endotracheal Intubation in the Medical Intensive Care Unit

Some caveats to highlight:

  1. They use pre-intubation vasopressors like norepinephrine to mitigate hypotension peri-intubation. Hence the relatively low rate of critical hypotension
  2. They have a well disciplined intubation team protocol which includes two persons dedicated to BVM in between attempts. The intubator is not allowed to be involved in BVM rescue. Hence the relatively low rate of critical desaturation.
  3. Oesophageal intubation rate is fairly high despite their routine use of video laryngoscope(Glidescope)
  4. The aspiration rate is still significant and one wonders if this could have been improved with routine use of paralytics.
  5. It is difficult to know how their approach can be generalised to other settings and indeed other ICUs
  6. Their frankness in publishing this data is to be commended
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