Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne.

The objective of this study is to describe the population of patients receiving emergency airway management outside operating theatres at our institution, a tertiary referral centre in Melbourne. A registry of all patients receiving emergency airway management in the emergency department, ICU and on the wards as part of Medical Emergency Response teams' care, was prospectively collected. There were 128 adults and one paediatric patient requiring emergency airway management recruited to the study. Data for analysis included patient demographics, pre-oxygenation and apnoeic oxygenation, staff, drugs, details of laryngoscopic attempts, adjuncts, airway manoeuvres, complications sustained and method of confirmation of endotracheal tube placement. Over a 12-month period, there were 139 intubations of 129 patients, requiring a total of 169 attempts. Respiratory failure was the most common indication for intubation. Intubation was successful on the first episode of laryngoscopy in 116 (83.5%) patients. Complications occurred in 48 patients. In the cohort of patients without respiratory failure, nasal cannulae apnoeic oxygenation significantly reduced the incidence of hypoxaemia (0 out of 31 [0.0%] versus 10 out of 60 [16.7%], P=0.016; absolute risk reduction 16.7%; number needed to treat: 6). Waveform capnography was used to confirm endotracheal tube placement in 133 patients and there were four episodes of oesophageal intubation, all of which were recognised immediately. In the critical care environment of our institution, emergency airway management is achieved with a first-attempt success rate that is comparable to overseas data. Nasal cannulae apnoeic oxygenation appears to significantly reduce the risk of hypoxaemia in patients without respiratory failure and the use of waveform capnography eliminates episodes of unrecognised oesophageal intubation.

The combined clinical and hemodynamic effects of trinitrin and propranolol.

The clinical and hemodynamic effects of trinitrin (nitroglycerin) have been studied in 5 patients with long-established coronary artery disease who had been receiving long-term beta blockade therapy (propranolol). 5 similar patients not on propranolol acted as controls. Patients on propranolol reported as effective relief of angina with trinitrin as patients not on this therapy. Although the patients on propranolol had an initially lower systolic blood pressure and mean ventricular rate, sublingual trinitrin caused in both groups a similar fall in aortic pressure, pulmonary wedge pressure, oxygen consumption and stroke volume, together with a similar rise in ventricular rate. It was concluded that trinitrin was as effective, both subjectively and objectively, in patients on propranolol as in those without beta blockade and promoted similar side effects.