ICU SAQs · Airway management
Rapid sequence intubation in a critically ill patient
A CICM SAQ on RSI — the sequence, drug choice in septic shock (ketamine; the etomidate adrenal controversy), and capnographic confirmation.
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Prompt
Outline the technique of rapid sequence intubation in a critically ill patient. State your choice of drugs for a patient in septic shock and justify it, and describe how you confirm correct endotracheal tube placement.
Question
Outline the technique of rapid sequence intubation in a critically ill patient. State your choice of drugs for a patient in septic shock and justify it, and describe how you confirm correct endotracheal tube placement.
[1] [4] [6]References7ShowHide
- [1]Gu WJ, Wang F. Single-dose etomidate does not increase mortality in patients with sepsis: a systematic review and meta-analysis. Chest, 2015.PMID 25255427
- [2]Chan CM, Mitchell AL, Shorr AF. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. Critical Care Medicine, 2012.PMID 22971586
- [3]Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet, 2009.PMID 19573904
- [4]Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia, 2018.PMID 29406182
- [5]Tran DT, Newton EK, Mount VA, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database of Systematic Reviews, 2015.PMID 26512948
- [6]Casey JD, Janz DR, Russell DW, et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine, 2019.PMID 30779528
- [7]Tessarolo E, Alkhouri H, Lelos N Review article: Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation in the emergency department: A systematic review. Emergency Medicine Australasia, 2022.PMID 35577760