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The need for preoxygenation in critically ill patients undergoing rapid sequence tracheal intubation is well established. Adequate preoxygenation with as close to 100% oxygen increases the safe apnoea time in these patients. The standard recommendation is spontaneous breathing with oxygen using a non-rebreather mask for a period of between 3 and 5 minutes. A study from a large US hospital set out to evaluate whether longer periods of preoxygentaion improved the Pa02. Arterial blood gases taken at 4, 6 and 8 minutes of preoxygenation revealed no significant improvement in oxygen tension after 4 minutes. This is reassuring in the already time critical scenario of a patient requiring tracheal intubation and mechanical ventilation (Crit Care Med 2009;37:68–71).


A recent Archives of Internal Medicine paper reports on a single centre double-blind trial of vasopressin-epinephrine and corticosteroids during and after cardiac arrest. One hundred patients were enrolled, receiving either vasopressin and epinephrine or epinephrine alone. The vasopressin group also received methylprednisolone at the end of the first …

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