This is the first randomized controlled trial published on DSI vs RSI in agitated patients...in this video I give my thoughts on the trial. Join this channel to get access to perks: / @salimrezaie
Thank you for reviewing the study and explaining it.. I think DSI should be considered in ICU and RRT for most of intubation needs Of course except Respiratory Distress p.t and elevated ICP This study will open more discussion about DSI vs RSI in septic shock for example What do you think doctor? Icu resident
Of course and my pleasure...the initial focus should not be the intubation, but the resuscitation that occurs before the intubation...fluids, pressors, pre oxygenation, etc...my two cents
A first pass failure rate that high is very odd to me and like you mentioned makes me question the individuals intubating and/or their equipment. This study should have been done with video/glidescope given that is the new standard imo. And though it is harder to study, did the period of hypoxia defined by the study have any clinical significance? Good discussion as always though.
Agreed...would have liked to see the study done with VL and more experienced clinicians but we get what we get when it comes to studies...as for outcomes... -No statistically significant difference in airway-related adverse events in either group (DSI 9% vs RSI 16%; p = 0.13) -- Although I would argue a 7% difference may be clinically significant -No episodes of hypotension, arrhythmias, or cardiac arrest in either group Appreciate the comment/thoughts/discussion
Why would they call a successful intubate with the just the blade making entry instead past the teeth instead of successfully placing the cuff past the vocal cords? That dose not seem real word realistic?
It’s gonna be hard to get buy-in for DSI from staff. Especially seasoned ED nurses in a high-pressure trauma situation. Not disagreeing-per se-just sayin’ is all.
We've always done it this way...Just doesn't cut it...DSI is the way to go in agitated trauma patients that need intubation...before it was expert opinion...now there is a RCT that confirms it...there will be early adopters, early majority, late majority, and then those who are stagnant...Evidence takes time to make it into clinical practice...I am doing my part to help speed that up...
Thank you for reviewing the study and explaining it..
I think DSI should be considered in ICU and RRT for most of intubation needs
Of course except Respiratory Distress p.t and elevated ICP
This study will open more discussion about DSI vs RSI in septic shock for example
What do you think doctor?
Icu resident
Of course and my pleasure...the initial focus should not be the intubation, but the resuscitation that occurs before the intubation...fluids, pressors, pre oxygenation, etc...my two cents
A first pass failure rate that high is very odd to me and like you mentioned makes me question the individuals intubating and/or their equipment. This study should have been done with video/glidescope given that is the new standard imo.
And though it is harder to study, did the period of hypoxia defined by the study have any clinical significance? Good discussion as always though.
Agreed...would have liked to see the study done with VL and more experienced clinicians but we get what we get when it comes to studies...as for outcomes...
-No statistically significant difference in airway-related adverse events in either group (DSI 9% vs RSI 16%; p = 0.13) -- Although I would argue a 7% difference may be clinically significant
-No episodes of hypotension, arrhythmias, or cardiac arrest in either group
Appreciate the comment/thoughts/discussion
Why would they call a successful intubate with the just the blade making entry instead past the teeth instead of successfully placing the cuff past the vocal cords? That dose not seem real word realistic?
To clarify…an attempt was laryngoscope past teeth…success was ETT in trachea…Does that make sense? Apologies if that wasn't clear in the video
It’s gonna be hard to get buy-in for DSI from staff. Especially seasoned ED nurses in a high-pressure trauma situation. Not disagreeing-per se-just sayin’ is all.
We've always done it this way...Just doesn't cut it...DSI is the way to go in agitated trauma patients that need intubation...before it was expert opinion...now there is a RCT that confirms it...there will be early adopters, early majority, late majority, and then those who are stagnant...Evidence takes time to make it into clinical practice...I am doing my part to help speed that up...