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Journal update
Journal update: monthly top five
  1. Ysabelle Elisha Thackray1,
  2. Johanna Walter2,
  3. Christina Evans3,
  4. Luisa Padovani3,
  5. David Birrell4,
  6. Jocelyne Velupillai2,
  7. Benjamin Clarke5,6,
  8. Patricia Van Den Berg7
  1. 1 Emergency Department, Royal Hospital for Children and Young People, Edinburgh, UK
  2. 2 Emergency Department, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  3. 3 Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  4. 4 Emergency Department, St John's Hospital at Howden, Livingston, UK
  5. 5 Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
  6. 6 Emergency Medicine Research Group of Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
  7. 7 Emergency Department, Wythenshawe Hospital, Manchester, UK
  1. Correspondence to Dr Ysabelle Elisha Thackray; ysabelle.thackray{at}nhs.scot

https://doi.org/10.1136/emermed-2024-214644

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    This month’s update is by the Emergency Medicine team in South East Scotland. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    Peri-intubation hypoxia after delayed versus rapid sequence intubation in critically injured patients on arrival to trauma triage: a randomized controlled trial by Bandyopadhyay et al

    Topic: Trauma

    Outcome rating: Head turner

    While many trauma patients require intubation, critically injured patients with agitation or confusion may struggle to tolerate standard preoxygenation. This study investigated whether delayed sequence intubation (DSI), with the administration of ketamine 3 min prior to muscle relaxant administration, improved peri-intubation oxygen saturation levels compared with standard rapid sequence intubation (RSI).1

    200 critically injured adult patients requiring intubation were recruited and randomised to either DSI with ketamine, followed by 3 min of preoxygenation and then paralysis and intubation, or a 3 min preoxygenation period followed by standard RSI induction. In DSI patients, the ketamine dose was increased gradually until dissociation was achieved. The primary outcome was incidence of peri-intubation hypoxia, defined as an SpO2<93% recorded from start of preoxygenation until 1 min postintubation. The study was powered based on a 20% absolute reduction in the primary outcome, requiring 97 patients in each trial arm.

    Peri-intubation hypoxia was significantly lower in the DSI group (8%) compared with the RSI group (35%), p<0.001. There was no statistically significant difference in airway-related adverse events.

    The main limitation is that SpO2 was not continuously monitored, but rather recorded at baseline, at 1 min intervals …

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    Footnotes

    • Contributors All authors were responsible for selection of papers. Summaries were written by JW, CE, LP, DB and JV. JW was responsible for editing. BC provided senior oversight. YET was responsible for organising, editing and manuscript submission. PVDB was responsible for editing and approving drafts.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.