Catch Your Breath: Bag-Mask Ventilation During Intubation & Liberal Oxygen Therapy in Acute Illness

Paxton Bach and Katie Wiskar, general internists in Vancouver, are back this week on The Rounds Table. Together they cover bag-mask ventilation during intubation of adults in intensive care units, and liberal versus conservative oxygen therapy in acutely ill adult patients.

In the non-operating room setting, some recommendations regarding rapid-sequence intubation suggest avoiding bag-mask ventilation to prevent aspiration.  On the other hand, hypoxemia during intubation results in major morbidity, contributing to peri-procedural arrest.  Katie shares an article that studied patients intubated in intensive care units and compares patients who received bag-mask ventilation between induction and laryngoscopy compared to those who did not receive bag-mask ventilation.  Outcomes in terms of oxygen saturations and incidences of hypoxemia are reported.

Supplemental oxygen often falls under the package of “standard care.” However, in recent years, the question has been brought up as to whether or not supplemental oxygen in patients who are not hypoxic can be actually harmful.  Next, Paxton shares a systematic review and meta-analysis of mortality and morbidity in acutely ill adults who are not severely hypoxic at baseline treated with liberal oxygen therapy versus conservative oxygen therapy (lower O2 target or room air).

Finally, the Good Stuff segment.  Katie shares a blog called In-House with articles written on the culture of residency and attempts at incorporating wellness.  Paxton discusses a study of tortoise-shaped pills that administer insulin via a needle when in the stomach – could this eliminate the need for insulin pumps and injections?

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Paxton Bach @paxbach and Katie Wiskar @katiewiskar.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. PreVent trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1812405

2. IOTA: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30479-3/fulltext

Good Stuff

1. Resident Wellness Is a Lie: http://in-housestaff.org/resident-wellness-is-a-lie-part-1-1319

2. Swallowing Needles: https://www.cbc.ca/radio/quirks/feb-16-2019-vaping-safety-breast-milk-pumping-evolution-experiments-and-field-mice-and-more-1.5019194/swallowing-needles-packed-in-a-turtle-shell-to-treat-diabetes-1.5019197

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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