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PHARM Podcast 180 What year is this? Intubation checklist year?

Hi folks

on todays episode I discuss a recent paper in regard to intubation checklist and its role if any in emergency department intubations. I did a public debate with Tim Leeuwenberg in 2014 at SMACCGOLD on this topic.

 Here is the full text article

A multicenter, randomized trial of a checklist for endotracheal intubation of critically ill adults

Some more reading on topic:

BET 2: SHOULD REAL RESUSCITATIONISTS USE AIRWAY CHECKLISTS?

Podcast ( available here and on iTunes)

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3 Comments Post a comment
  1. DIR C WILLIAM #

    1. I’m no expert in statistics, but don’t think the sample size in the Chest article was anywhere close to being large enough to show differences in the rare, but potentially deadly events that checklists should really help us with. It’s the unexpected can’t ventilate/can’t intubate scenario where you want all your backup tools present. If your checklist makes someone confirm that surgical airway kit is really where it is supposed to be on your airway cart… A study might need an n in the tens of thousands to capture these events. Like the airline industry, we want to prevent the “almost-never” events and checklists are more likely to help with this than be of real benefit in our routine cases.

    2. The rate of post-intubation hypoxemia is unacceptably high, in my opinion. Based on lowest pO2 in 6 hours prior, I don’t think this was due to an unusually sick group of patients. Perhaps a checklist that included providing apneic oxygenation and having a PEEP valve present would have allowed the study group to diverge from the controls. Additionally, having push-dose ino/vasopressors at the bedside might have allowed some divergence in the cardiovascular collapse groups.

    William Dir MD
    ICU Nocturnist

    October 6, 2017
    • Thanks for the feedback ! Sounds like you agree Training is issue not having the perfect checklist !

      October 6, 2017
      • DIR C WILLIAM #

        I agree that skill and expertise trumps a list! But, I think it would take a different study with the “right” list to really prove non-inferiority of not using a checklist, especially with trainees/infrequent intubators.

        October 6, 2017

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