Severely injured children account for only asmall proportion of emergency medical service (EMS) missions but pose major challenges to the emergency teams due to age-related anatomy and physiology, complex injury patterns and high emotional stress. This narrative review summarizes the current evidence on the epidemiology and prehospital management of pediatric trauma patients in the German EMS system and places these findings in an international context. APubMed search was carried out using the terms "children", "trauma" and "prehospital". Studies reporting the prehospital management of injured children and adolescents were included. Out of 421 records 20studies were selected and complemented by backward citation searches, with afocus on data from Germany and comparable high-income countries. Pediatric emergencies account for approximately 5% of ground EMS (GEMS) and 6-13% of helicopter EMS (HEMS) missions; severely injured children (e.g. NACA IV-VII) constitute only asmall fraction, making pediatric polytrauma aclassical low-frequency, high-impact scenario. The proportion of traumatic emergencies increases with age and peaks during adolescence; boys are overrepresented in all cohorts. Falls and traffic incidents dominate, predominantly resulting in blunt trauma with injuries mainly to the head and extremities. Polytrauma is reported in only around 5% of injured children and primarily affects older children and adolescents. Oxygen administration, intravenous access, immobilization and analgesia are frequent measures, whereas intubation, intraosseous access, chest drainage and other invasive procedures are rare. Several studies indicate an association between HEMS or direct admission to a(pediatric) major trauma center and improved survival. Pediatric trauma patients represent asmall but high-risk group in whom invasive procedures must be performed under time pressure and emotional stress. The management of complex cases by specialized HEMS teams and clearly designated (pediatric) major trauma centers, the strengthening of paramedic-based care, simulation-based training, standardized prehospital and in-hospital outcome-oriented data collection and the further expansion of regionally coordinated trauma networks are key steps towards improving prehospital care for injured children.

Transmission of respiratory infectious diseases based on real close contact behavior in an emergency room.

The emergence of videolaryngoscopy has transformed airway management, being widely adopted for tracheal intubation, and enhancing glottic visualization, especially in complex scenarios. Continuous research is crucial to evaluate the efficacy of various designs. This study aims at evaluating the usability and safety of videolaryngoscopes in novice intubation simulations. This study compares the impact of LANJA, UE, and VDO video laryngoscopes on simulated endotracheal intubation by beginners. This non-randomized concurrent controlled simulation study involved 29 medical student volunteers with no prior endotracheal intubation experience. Following theoretical training by experienced anesthesiologists, participants watched intubation demonstration videos and engaged in hands-on practice. Using LANJA, UE, and VDO video laryngoscopes in random order, participants performed endotracheal intubation on a simulated airway mannequin. Observers recorded intubation procedure videos, analyzing intubation time, success rate, and laryngoscope exposure grading. Significant differences were observed in the time required for glottic exposure with the 3 laryngoscopes (intubation visualization time; LANJA: 5.47 ± 2.84; UE: 9.29 ± 2.88; VDO: 8.97 ± 2.99, P = .001). The endotracheal tube placement time (visualization and fixation time) did not differ significantly among the laryngoscopes (LANJA: 25.21 ± 7.35; UE: 25.04 ± 7.75; VDO: 27.66 ± 3.80, P = .31). Overall intubation success rates varied significantly among the 3 laryngoscopes (LANJA: 89.5%, UE: 78.9%, VDO: 63.2%, P = .002); within Cormack–Lehane grades, LANJA showed the highest percentage in Grade I (68.8%). LANJA video laryngoscope demonstrated a higher success rate in guiding endotracheal intubation, reducing glottic exposure time, and is suitable for use by beginners.

(1) Background: Ground Emergency Medical Services in Hungary are provided by the National Ambulance Service. Paramedics, physicians, and specialists in this service are competent in performing endotracheal intubation (ETI) on patients. The aim of this study is to evaluate the impact of the standardized Rapid Sequence Intubation (RSI) procedure on safety and effectiveness. (2) Methods: A retrospective observational study was conducted concerning the RSI procedure. Patient documentation from a 2-year implementation period was analyzed using a dedicated Case Report Form (CRF), where both RSI and non-RSI methods were used. Our primary endpoint was Definitive Airway Sans Hypoxia and Hypotension on First Attempt (DASH-1A). Our secondary endpoints included success on the first attempt; overall success; and hypoxia, hypotension, and cardiac arrest complications. (3) Results: In total, 6399 intubation cases were studied; non-RSI was used in 3236, and RSI was applied in 3163 cases. DASH-1A was attained in a significantly higher number of cases with RSI than non-RSI (55.0 vs. 68.5%, p < 0.0001). The DASH-1A results of the RSI group were significantly better in the paramedic (54.0 vs. 68.5%, p < 0.0001) and the physician (55.0 vs. 66.7%, p = 0.0017) subgroups. In the specialist subgroup, the difference was not statistically significant (64.5 vs. 69.7%, p = 0.1514). (4) Conclusions: Standardized RSI significantly increased effectiveness and safety in the paramedic and physician subgroups.

Rapid sequence intubation (RSI) is critical for airway management in emergency departments (ED). This study investigates sex-based differences in RSI outcomes, exploring how biological, pharmacological and psychosocial factors may influence intubation success and complications. Data from 5021 intubation episodes (January 2010-March 2017) across 42 EDs in Australia and New Zealand was analysed from the ANZEDAR study. Variables including intubation indications, patient factors and complications were stratified by sex. Multivariable logistic regression was used to identify factors associated with first-pass success (FPS) and complications. Males were more frequently intubated for trauma, while females had higher rates of medical indications such as overdose or stroke and had a higher shock index. Males had a higher predicted and observed difficult laryngoscopy and a lower FPS rate. Additionally, males had a higher overall complication rate, and more desaturation events. Females had a higher incidence of mainstem bronchus intubation. Despite a higher predicted difficulty in males, there were no significant differences in clinical practices such as positioning, use of video laryngoscopy or staff seniority. Sex-related differences were observed in this registry, with males experiencing lower FPS and more complications. These findings are exploratory; prospective studies should test whether sex-aware assessment and preparation improve process measures and patient outcomes.

Submental intubation offers a safe and less invasive alternative to tracheostomy in maxillofacial trauma patients when oral or nasal intubation is contraindicated. This study aimed to assess the safety, complications, and long-term outcomes of submental intubation over a five-year period (2018-2023), with a novel emphasis on salivary gland evaluation using ultrasonography. A retrospective cohort study was performed on 31 patients who underwent submental intubation between 2018 and 2023 at Sina Hospital, Tehran University of Medical Sciences. Clinical assessments included intraoperative and postoperative complications, scar outcomes, and lingual nerve function. Ultrasonographic examinations of submandibular and sublingual glands were conducted to detect volumetric and echoparenchymal changes, with comparisons made between the incision and contralateral intact sides. Statistical analysis employed paired t-tests and Wilcoxon signed-rank tests. Submental intubation was successfully performed in all patients with a mean operative time of 7 ± 2min. No major intraoperative or postoperative complications such as bleeding, hematoma, or infection were observed. Scar appearance was acceptable in all cases, with only two patients developing widened scars and none exhibiting hypertrophic scars. Ultrasonography revealed normal echoparenchyma in 90.3% of cases. Three patients showed hyperechoic parenchyma with reduced gland volume on the incision side, potentially attributable to previous trauma rather than the intubation procedure. No significant differences in gland volume were detected between the incision and intact sides (p = 0.165). Submental intubation is a safe, effective, and minimally invasive airway management technique for maxillofacial trauma patients, associated with minimal complications and favorable cosmetic outcomes. This five-year study provides new ultrasonographic evidence confirming the safety of salivary gland function. Further studies with extended follow-up are recommended to exclude rare late-onset complications such as mucoceles or ranulas.

Background and aimsBronchopulmonary dysplasia (BPD) represents a persistent respiratory condition that primarily affects preterm infants, distinguished by abnormal lung development and function. Previous studies have indicated a significant association between the pulmonary microbiome and various respiratory diseases. This study aimed to compare the airway microbiome composition and its temporal changes in preterm infants with and without BPD.MethodsWe conducted a cohort study involving 14 infants diagnosed with BPD and 10 preterm infants without BPD, all born at a gestational age (GA) < 32 weeks. Tracheal aspirates were collected on day 1 during intubation, as well as on days 7 and 14 following the intubation procedure. Subsequently, bacterial DNA was extracted, and the 16S rRNA genes were amplified and sequenced to characterize the airway microbiome.ResultsThe demographic and clinical features, such as gestational age, birth weight, and sex ratio, were similar across the groups. However, BPD infants required prolonged duration for Continuous Positive Airway Pressure (25.0 d vs 8.5 d, P = 0.001), oxygen therapy (38.0 d vs 20.5 d, P = 0.001), antibiotic treatment (9.5 d vs 4.5 d, P = 0.004), and prolonged hospital admissions (44.0 d vs 25.5 d, P = 0.002). Microbiome analysis revealed that the BPD infants exhibited reduced bacterial diversity at birth and a consistent pattern of diminished bacterial diversity over time compared to the non-BPD group, as indicated by a lower Shannon index. The BPD group also showed a distinct microbial community composition, with significant differences in β-diversity observed at day 14 post-incubation. At the phylum level, both groups exhibited an increase in Firmicutes in the first two weeks, while the BPD group showed a progressive decline in the relative abundance of Bacteroidetes. At the genus level, the BPD infants exhibited an increased proportion of Streptococcus and Acinetobacter, and a decreased abundance of Prevotella over time.ConclusionsThese findings indicate that the airway microbiome in infants with BPD is characterized by reduced diversity and distinct microbial profiles, which may contribute to the pathogenesis of the disease. Understanding these microbiome dynamics may help develop targeted therapeutic strategies aimed at modulating the microbiome to prevent or mitigate BPD in preterm infants.

Background: Tuberculosis transmission in healthcare is poorly understood. Exposure definitions for patients and healthcare workers tend to be based on custom rather than data leading to many people being flagged for evaluation despite few infection transmission events. We reviewed the medical literature to identify and quantify risk factors for tuberculosis transmission in healthcare to guide risk-stratification and inform exposure definitions. Methods: We reviewed MEDLINE, EMBASE, CINAHL and Cochrane databases from inception to December 10, 2024. We included studies reporting tuberculosis transmission from infected adult patients to healthcare workers and other patients in both inpatient and outpatient settings. We evaluated 12 transmission risk factors: contact factors (exposure duration, proximity of exposure, mask use, room ventilation), patient factors (smear positivity, NAAT positivity, cavitary pulmonary disease, respiratory symptoms), and procedure factors (intubation, bronchoscopy, sputum collection, and other procedures). Results: A total of 6,695 studies were identified of which 49 met inclusion criteria. Contact factors associated with increased risk of transmission included poor room ventilation (≤ 2 air exchanges per hour, 60-70% air recirculation without high efficiency filtration, high ambient carbon dioxide levels with median 660-800 parts per million) and positive pressure air flow from poorly ventilated rooms to nearby clinical spaces. Most ventilation-related transmissions occurred before modern healthcare ventilation standards were implemented. Sustained proximity to infected patients was associated with patient-to-patient transmission via shared rooms (4 transmissions/90 exposures, minimum exposure ≥16 hours) and prolonged residence adjacent to a poorly ventilated standard pressure room (42 transmissions/430 exposures, minimum exposure ≥24 hours). Amongst 766 cases of tuberculosis transmission from patients to healthcare workers, risk factors included prolonged patient contact (median 6 hours, minimum 30 minutes), failure to wear an N95 respirator, and face-to-face patient care (28% of transmissions were associated with face-to-face patient contact, 21% of transmissions were associated with working on the same unit without direct patient contact, and contact details were unknown in 52% of transmissions). Patient factors associated with increased transmission included cavitary disease (OR 1.90, 95% CI 1.26-2.84). Transmission risk was similar for smear-positive and smear-negative patients undergoing aerosol-generating procedures without airborne precautions (17/111 smear negative exposures led to transmission vs 32/166 smear positive exposures, 15% vs 19%). All transmissions to healthcare workers associated with intubation, bronchoscopy and induced sputum collection occurred without airborne precautions. Conclusions: Detailed review of the circumstances around nosocomial tuberculosis exposure helps identify transmission risk factors that can inform more evidence-based, detailed and individualized exposure definitions.

Perioperative ventilation support, what clinicians and searchers must know.

Did intubation procedures for critically ill patients without SARS-CoV-2 infection change during the pandemic? Secondary analysis of the INTUPROS multicenter study.

Airway-related incidents, common in clinical settings, are characterized by high urgency and complexity. Failure to manage these incidents promptly can pose serious threats to patient safety. However, many of these incidents can be prevented through the effective implementation of airway management education. The objective of this study was to identify the priority educational needs of airway management for nurses to enhance clinical practice and reduce the risk of adverse events. A cross-sectional design was employed and 100 nurses from a medical center in northern Taiwan were enrolled as participants. Data were collected via an online questionnaire and analyzed using importance-performance analysis (IPA), Borich's Needs Score, and the Locus for Focus (LF) model, all of which have previously been shown to be effective in identifying educational priorities. Items identified as top-priority educational needs were respectively located in Quadrant II of the IPA model, ranked among the top-10 in terms of Borich's Needs Score, and situated in Quadrant I of the LF model. The results highlighted "rapid sequence intubation procedures" and "treatment of respiratory failure" as the areas in most need of attention. The results of this study support that significant gaps exist between the perceived importance and self-assessed performance of nurses with regard to airway management. In this study, these gaps were most significant in the dimensions of rapid sequence intubation procedures and respiratory failure treatment. Targeted, outcome-focused educational programs are recommended to address these gaps to improve patient safety and the quality of clinical nursing care.

Noninvasive respiratory supports are routinely applied in critically ill patients with acute respiratory failure to avoid intubation and invasive mechanical ventilation, thereby reducing the risk of related complications, and to facilitate successful weaning from mechanical ventilation after extubation. They are also applied during the intubation procedure for preoxygenation with the aim of enhancing oxygenation and ensuring the safety of the procedure. High-flow nasal oxygen decreases airway dead space, provides a stable concentration of inspired oxygen, generates low level of flow-dependent positive airway pressure, and optimizes comfort. Positive-pressure noninvasive supports include continuous positive-airway pressure and noninvasive ventilation and enable providing higher end-expiratory pressure, thereby further improving oxygenation. Noninvasive ventilation, but not continuous positive-airway pressure, better decreases inspiratory effort, and increases tidal volume and transpulmonary driving pressure. High-flow nasal oxygen has become the first-line therapy in acute hypoxemic respiratory failure, while noninvasive ventilation remains the reference treatment during exacerbations of chronic obstructive pulmonary disease, in patients with respiratory acidosis. In patients requiring intubation, noninvasive ventilation is the optimal technique for preoxygenation to decrease the risk of hypoxemia, while high-flow nasal oxygen is an alternative option for non-hypoxemic patients or those with contraindications to noninvasive ventilation. After extubation in patients at high risk of reintubation, prophylactic noninvasive ventilation, eventually alternating with high-flow nasal oxygen, improves weaning outcome compared to other strategies; high-flow nasal oxygen alone outperforms conventional oxygen in low-risk patients.

Pediatric out-of-hospital tracheal intubation is associated with lower success rates compared with adult populations and presents distinct clinical challenges. Achieving success on the first attempt is critical, as multiple intubation attempts are associated with an increased risk of adverse events. The aims were to identify factors available before laryngoscopy that are independently associated with first-attempt success in pediatric out-of-hospital intubation and to evaluate the performance of a gestalt evaluation of intubation difficulty scale. Data were extracted from a retrospective, observational, multicenter cohort study conducted in three physician-staffed mobile intensive care units (ICUs) in France. The study included patients aged 0-17 years who required out-of-hospital airway management. The primary outcome was successful intubation on the first attempt. A multivariable logistic regression model was constructed including clinically relevant variables available before laryngoscope insertion. A total of 206 pediatric patients were included in the analysis, with a median age of 6 years (interquartile range: 1-16). The overall first-attempt success rate was 59.7% [95% confidence interval (CI): (52.7-66.4)]. In the multivariable analysis, patient age [adjusted odds ratio (aOR): for 2-9 years, 2.33, 95% CI: (1.00-5.39); for 10-17 years, 3.86, 95% CI: (1.55-9.60); reference: 0-1 years] and presence of a soiled airway before laryngoscopy [aOR, 0.38, 95% CI: (0.20-0.71)] were independent predictors of successful intubation on the first attempt. The gestalt evaluation of the intubation difficulty scale yielded an area under the receiver operating characteristic curve of 0.63, 95% CI: (0.56-0.71), and it showed only a weak correlation with the Cormack-Lehane grade (Kendall tau-b = 0.36; P < 0.001). In this cohort of pediatric tracheal intubation procedures performed by physician-staffed mobile ICUs, soiled airways and younger age were associated with a lower incidence of first-attempt success. The gestalt evaluation of intubation difficulty demonstrated poor discriminative ability.

ABSTRACT Introduction: Severe traumatic brain injury (TBI) is responsible for millions of cases and high mortality worldwide. Initial management and care in the intensive care unit, especially controlling hypotension and elevated intracranial pressure (ICP), are fundamental for prognosis. Guidelines recommend maintaining ICP below 22 mmHg and systolic blood pressure above 90 mmHg. Treatment includes sedation with short-acting medications, which can cause hypotension. Ketamine, an NMDA receptor antagonist, is widely used as a sedative in the ICU, especially in patients with hemodynamic instability, as it increases cardiac output and blood pressure. Despite this, its use in TBI cases has historically been limited due to the risk of increased ICP. However, smaller studies have not shown an increase in ICP with ketamine and have even suggested a reduction, in addition to indicating its neuroprotective potential. Objective: To analyze the effects of ketamine in patients with traumatic brain injury, focusing on its influence on ICP and associated neurological outcomes. Methodology: A narrative literature review conducted in June 2025, with searches in the PubMed and Virtual Health Library (BVS) databases. Standardized descriptors from Medical Subject Headings (MeSH) and Health Science Descriptors (DeCS) were used, including the English terms ketamine AND (brain injury OR traumatic brain injury) AND (intracranial pressure OR intracranial hypertension OR ICP), and the Portuguese terms Pressão Intracraniana AND Lesão Cerebral traumática AND Cetamina. Results and Discussion: Six studies were included in the review after applying eligibility criteria. The evidence indicated that ketamine did not increase ICP in most cases, being associated in some studies with its reduction, as well as improving cerebral perfusion pressure. Additionally, no significant neurological adverse effects related to ketamine use were observed, even in rapid intubation procedures and pediatric patients. Conclusion: It is concluded that ketamine is a safe and effective option for sedation in patients with TBI, even in emergencies, challenging previous concerns and expanding therapeutic possibilities in critical situations. Keywords: Intracranial pressure; Traumatic brain injury; Ketamine.

This study aims to systematically review all adverse events (AEs) associated with orotracheal intubation in pediatric patients, with the ultimate goal of aiding healthcare center administration in establishing evidence-based guidelines and devising preventive strategies to mitigate AEs in pediatric intubation procedures. Systematic automated searches across pivotal databases were conducted up to 2023. The screening process was facilitated by EndNote X9 following the importation of citations. Data extraction was guided by predefined eligibility criteria after the elimination of duplicates and ineligible publications. The National Institutes of Health (NIH) quality evaluation instrument was employed to assess biases. A total of twenty-four studies spanning from 2002 to 2023, encompassing 7135 patients were included in the analysis. Among the identified adverse events, moderate desaturation(≤90%) emerged as the most prevalent, affecting 508/2398 (23.9%, 95% CI: 17.6% to 30.3%) of cases across 13 studies. Mainstem intubation was observed in 342 out of 4,481 cases (9.1%, 95% CI: 6.3% to 11.9%) and in 173 out of 3903 cases (3.9%, 95% CI: 2.5% to 5.3%), making these significant AEs. Cardiac complications, including arrhythmias 55/3858 (1.2%, 95% CI: 0.6% to 1.8%), hypotension 121/4536 (2.6%, 95% CI: 1.5% to 3.7%), and cardiac arrest 105/4836 (1.4%, 95% CI: 0.7% to 2.2%), were observed in 10, 11, and 11 trials, respectively. Severe complications, with an incidence rate of 274/3298 (8.8%, 95% CI: 4.2% to 13.3%), were reported in five studies. This comprehensive investigation and subsequent meta-analysis of adverse events associated with pediatric intubation provide valuable insights that can inform the development of enhanced safety protocols and evidence-based guidelines for pediatric emergency care. High Success Rate with Complications: An 84.7% intubation success rate is reported, with a 30.1% complication rate, including desaturation, mainstem and esophageal intubation, and cardiac issues. Need for Enhanced Safety Measures: Findings stress the importance of better training and standardized protocols to reduce complications in pediatric emergency intubation. Focus on Adverse Events: This study uniquely highlights adverse events, offering crucial data for developing guidelines to improve safety in pediatric intubation.

Introduction The objective of this study was to compare the practicality and efficacy of utilizing a view-adjustable video laryngeal mask (SafeLM) versus endotracheal intubation (ETI) in the context of arthroscopic shoulder surgery. Patients and Methods A randomized controlled trial enrolled 100 patients undergoing arthroscopic shoulder surgery, randomly assigned to the SafeLM group (n = 50) or ETI group (n = 50). The primary outcome measure was hemodynamic parameters, while mechanical ventilation parameters, complications, and the quality of anaesthesia recovery were considered as secondary outcomes. These parameters were then compared between the two groups. Results During the intubation and extubation procedures, the SafeLM group demonstrated significantly lower mean arterial pressure and heart rate compared to the ETI group (p < 0.001). Furthermore, the airway pressure at T2 and T3 was notably lower in the SafeLM group compared to the ETI group (p < 0.001). However, there were no statistically significant differences in oxygen saturation observed between the two groups at any time point. Both groups were equally capable of quickly establishing a surgical airway when necessary. Notably, a smaller proportion of patients in the SafeLM group exhibited negative reactions during tube removal. Additionally, there was a statistically significant difference in the occurrence of post-operative sore throat, difficulty swallowing, choking, and coughing between the two groups (p < 0.001). Conclusions The utilization of SafeLM may result in enhanced regulation of blood pressure and heart rate among patients who undergo arthroscopic surgery for the shoulder while in the side decubitus position.

BackgroundIn recent years, Taiwan’s medical education has increasingly emphasized simulated learning, particularly through advanced manikins designed for procedural training, including endotracheal intubation. Although key indicators and predictive techniques for assessing complexity have been documented, their use in evaluating these manikins remains notably lacking.The aim of this study was to appraise the potential association between our devised scoring system and the actual outcome of intubation procedures. Subsequently, this scoring system could potentially serve as an objective yardstick for quantifying the intricacy of training simulators.MethodsNineteen post-graduate or emergency medicine trainees participated in this study. Intubation training involved four manikins, each with varying difficulty scores based on neck circumference, thyromental distance, airway obstruction, and Mallampati grade 3/4. Training modules included standard, advanced, and small adult intubation. Independent variables were training models and operator skill levels, while dependent variables included intubation time, success rate, tooth injury, gastric insufflation, uninflated cuff mishaps, perceived difficulty (rated 1–5), and laryngoscopy view quality (rated 1–4).Results and discussionIntubation parameters were recorded for comparison across subgroups. Mean intubation times for models A, B, and D were 42.67 ± 15.32 seconds, 48.73 ± 17.54 seconds, and 50.22 ± 18.40 seconds, with success rates of 89.47%, 78.95%, and 68.42%, respectively. Model ‘C’ had the highest difficulty score (4.430 points), the longest intubation time (58.84 ± 22.63 seconds, P <.001), and the lowest success rate (57.89%, P <.001), and was rated most difficult by participants. Notably, subsequent intubation attempts showed reduced time and complexity compared to the initial one.In conclusions, our devised scoring metric demonstrated a remarkable congruence with the tangible outcomes of the challenging endotracheal intubation training model. This outcome lends credence to the potential applicability of our formula not only in assessing the intricacy of existing models but also as a guiding benchmark for the innovation and refinement of novel training manikins.

Comparison of video laryngoscopy and direct laryngoscopy for urgent intubation in newborn infants: A meta-analysis.

Patients with infectious diseases often exhibit severe respiratory distress and breathing difficulties in isolation wards. Tracheal intubation is performed manually to secure the airway by health care providers wearing personal protective equipment to prevent infection spread and getting infected. This paper presents the navigation and preoperative positioning of an autonomous mobile intubation robot capable of independently moving to the patient's bed, positioning the intubation device inside the mouth while the operator completes the intubation procedure remotely, and the robot exits the location independently. The mobile base navigation module includes mapping, localization and path planning using the R3 live multi-sensor fusion algorithm utilizing sensor imputs from lidar, inertia measurement unit (IMU) and RGB-D camera, YOLOv5s object detection and avoidance algorithm and improved A* global path planning algorithm together with time elastic band (TEB) local path planning algorithm respectively. The preoperative positioning module based on facial pose estimation using the retinaface algorithm combined with 6DRepNet to obtain facial pose. This is validated in simulation and physical experiments. The system's navigation time and positioning accuracy compared with related indicators of endotracheal intubation surgery obtained significantly improved results.

The objective of this article is to clinically compare the inducing drugs ketamine and etomidate during the orotracheal intubation procedure in critically ill patients, aiming to reduce early mortality and other important complications involved in this act. This study is compliant to the PRISMA guidelines for systematic review and meta-analysis. A sensitive search was conducted using the databases PubMed (MEDLINE), Scopus, Lilacs (BVS), and Cochrane Library (Central). Our protocol included only randomized clinical trials, from the inception of the databases up to June 2024. Studies were selected if they compared ketamine to etomidate specifically for rapid sequence induction and intubation in critically ill patients. The outcomes assessed were: (1) all-cause mortality; (2) post-intubation arterial hypotension; (3) use of vasoactive drugs post-intubation; and (4) the incidence of adrenal insufficiency in the patient groups. With the sensitive search strategy in question, we have identified 956 studies. Among these, 10 randomized clinical trials met the inclusion criteria, collectively involving a total of 2862 patients. Ketamine demonstrated comparable effectiveness to etomidate in preventing all-cause mortality (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.65-1.21; P = .06). The rates of arterial hypotension post-intubation were also similar between the groups (OR = 1.28; 95% CI: 0.96-1.7; P = .34) and the same could be found when comparing the use of vasoactive drugs post-intubation (OR = 0.68; 95% CI: 0.36-1.27; P = .001). However, ketamine was less associated with adrenal insufficiency (OR = 0.35; 95% CI: 0.15-0.86; P = .008). Ketamine and etomidate demonstrated comparable effectiveness for rapid sequence intubation in terms of mortality and post-intubation hypotension. However, ketamine was associated with a lower risk of adrenal insufficiency, suggesting it may be a preferable option when patients are at high risk for adrenal suppression.