Intra-tracheal malposition of endotracheal tubes in newborns: a retrospective single-center study.

Incidence and prevalence of mouth mucosal pressure injury in patients receiving oral endotracheal intubation in the ICU: A systematic review and meta-analysis.

Magnitude and associated factors of difficult airway in adult patients undergoing elective maxillofacial surgery with endotracheal intubation at selected public hospitals, Addis Ababa, Ethiopia, 2021: A cross-sectional study

Procedural Outcomes of Minimally Invasive Surfactant Therapy: An International Matched Cohort Study.

Outcomes associated with ketamine administration following traumatic brain injury.

With the growing availability of bedside point-of-care technologies, an expanding body of evidence questions the necessity of routine daily chest radiographs in pediatric intensive care unit (PICU) patients. Nevertheless, this review illustrates that daily chest imaging continues to yield clinically meaningful information and should not be entirely discontinued. Routine daily chest radiographs in the PICU frequently reveal malpositioned devices including central venous catheters, chest tubes, nasogastric tubes, and endotracheal tubes. They may also uncover unanticipated cardiopulmonary abnormalities that warrant changes in management. Moreover, the potential risks of radiation exposure can be mitigated through the use of portable imaging and targeted scanning techniques that limit exposure to essential regions. Routine daily chest radiographs continue to be a valuable tool for pediatric intensivists and have the potential to identify unexpected complications that can significantly influence patient management. Future research should focus on risk stratifying pediatric patient populations which may benefit from routine chest radiography.

Perioperative use of eculizumab in patients with thymoma-associated myasthenia gravis: A preliminary case series of five patients.

Oxygenation Through the Working Channel of Fiberscope During Awake Tracheal Intubation in Severe Glottic Edema Following Caustic Agents Injury.

Practice changing articles: Video laryngoscopy versus direct laryngoscopy for tracheal intubation.

ObjectiveTo synthesize published clinical evidence on post-intubation lingual edema, focusing on pathophysiology, clinical presentation, diagnosis, management, and prevention strategies.MethodsA narrative review was performed using PubMed, Scopus, and EMBASE from inception through April 2025. Search terms included "tongue edema," "macroglossia," "lingual edema," "endotracheal intubation," "airway management," and "critical care." Eligible English-language reports describing lingual edema in adults following endotracheal intubation were included and synthesized qualitatively.ResultsA total of 48 studies were included, consisting predominantly of case reports, case series, and observational studies.ConclusionsPost-intubation lingual edema is an uncommon but potentially life-threatening complication. Early recognition, mechanism-directed management, and preventive strategies, including atraumatic airway techniques, optimal positioning, frequent reassessment and device repositioning, and selective consideration of bradykinin-targeted therapy when angioedema is suspected, are critical to reducing morbidity.

In the delivery room, newborn respiratory failure precedes cardiac failure, emphasizing the importance of effective ventilation. Face masks for ventilation may cause air leakage around the mask with subsequent suboptimal lung pressure, and intubation requires skilled providers. Laryngeal mask airways (LMA) may provide a more stable airway interface, with improved seal and more consistent ventilation that is less dependent on provider technique. An evaluation of the feasibility, acceptability, and initial outcomes of implementing the laryngeal mask airway as the first-line approach for ventilation in late preterm and term infants was conducted in a high-resource, urban safety-net hospital with a level III neonatal intensive care unit (NICU). The LMA was introduced and promoted as the firstline for delivery room ventilation in infants ≥35 weeks gestational age and ≥1.5 kg from August 2023 to August 2024. Implementation was supported by comprehensive training, survey feedback, and multidisciplinary involvement. The program evaluation spanned a 2-year period from August 2022 to August 2024. Feasibility and acceptability data were collected via provider surveys, and neonatal outcomes were compared pre- and post-implementation from electronic health record data. During implementation, LMAswereused as first-line in 58.7% of eligible neonates indicated for delivery room ventilation. Provider surveys showed increased knowledge and confidence in LMA use after education and high comfortability with LMA implementation in the delivery room. NICU admission rates, delivery room endotracheal intubations, chest compressions, and epinephrine use were similar across groups. Providers across experience levels successfully inserted LMAsafter brief training. LMA as first-line ventilation yielded similar outcomes to face mask in an urban safety-net hospital. Future research should explore broader applicability.

The percentage of glottic opening (POGO) score quantifies the laryngeal view obtained during laryngoscopy. This secondary analysis of the prospective observational PeDiAC study aimed to compare the POGO score with subjective glottic view ratings on a visual analogue scale (VAS) for classifying difficult videolaryngoscopic tracheal intubation. Videolaryngoscopy was used as the first-line approach for tracheal intubation in children over a study period of 16 months. Immediately after tracheal intubation, the airway operators documented a VAS rating of 0-100, with higher values indicating better glottic views. Using videolaryngoscopy recordings of airway management, POGO scores were assigned in a post-hoc analysis. The study comprised 904 tracheal intubations in 809 children. Difficult videolaryngoscopic tracheal intubation occurred in 47 (5.2%) cases. The POGO score had poorer diagnostic performance than VAS rating for classifying difficult videolaryngoscopic tracheal intubation, with AUROCs of 0.52 95%CI (0.42-0.62) and 0.79 (95%CI 0.73-0.86), respectively, p < 0.001. Based on the AUROC, the POGO score had a poorer diagnostic performance than VAS rating for predicting multiple laryngoscopy attempts (0.46 (95%CI 0.40-0.51) vs. 0.66 (95%CI 0.61-0.71), p < 0.001); multiple tracheal intubation attempts (0.45 (95%CI 0.41-0.50) vs. 0.64 (95%CI 0.60-0.68), p < 0.001); time to tracheal intubation > 90 s (0.45 (95%CI 0.40-0.51) vs. 0.70 (95%CI 0.65-0.75), p < 0.001); airway-related adverse events (0.51 (95%CI 0.41-0.61) vs. 0.65 (95%CI 0.57-0.74), p = 0.030); and severe hypoxaemia (0.47 (95%CI 0.35-0.59) vs. 0.63 (95%CI 0.52-0.73), p = 0.047). A POGO score < 50% had low positive predictive value of 0.11 (95%CI 0.04-0.22) and sensitivity of 0.13 (95%CI 0.05-0.27) for the occurrence of a difficult videolaryngoscopic intubation and the POGO score showed limited inter-rater reliability (intraclass correlation coefficient 0.61 (95%CI 0.47-0.72)). The POGO score has poor diagnostic performance for classifying difficult videolaryngoscopic tracheal intubation and low inter-rater reliability in children.

Neuromuscular blockade dose may affect intubation success on the first attempt, thereby impacting outcomes for patients undergoing emergency tracheal intubation. To evaluate the association between rocuronium dose and tracheal intubation outcomes among adults undergoing emergency tracheal intubation in the emergency department (ED) and intensive care unit (ICU). We conducted a secondary analysis of data from 2 multicenter randomized controlled trials studying airway management in the ED and ICU. We compared patient characteristics and intubation outcomes between patients receiving high-dose (>1.2 mg/kg) versus standard-dose (≤1.2 mg/kg) rocuronium. The primary outcome was successful intubation on the first attempt. We used propensity matching to account for measured potential confounders, stratified by setting. Participating sites included 9 EDs and 24 ICUs in the United States. Among 2,440 patients in the trial datasets, we included the 1,822 (74.7%) patients who received rocuronium in the current analysis. Of these, 720 (39.5%) received high-dose rocuronium and 1,102 (60.5%) received standard-dose rocuronium. Participants receiving high-dose rocuronium had higher probability of successful intubation on the first attempt (adjusted relative risk [RR] 1.06, 95% confidence interval [CI] 1.01-1.11). This difference in the primary outcome was not present for ED intubations (adjusted RR 0.97, 95%CI 0.90-1.04) but was present for ICU intubations (adjusted RR 1.12, 95% CI 1.05-1.19). In this secondary analysis, high-dose rocuronium (>1.2 mg/kg) was associated with higher first-attempt success. Given the potential for unmeasured confounding, these findings warrant evaluation in a randomized controlled trial.

The intensive care unit (ICU) is a critical environment where patients are at risk for developing medical device-related pressure injuries (MDRPIs). This review aims to synthesize the literature and assess the prevalence, causes, and risk factors of MDRPIs, particularly in the context of the COVID-19 pandemic. A systematic review was conducted to guide this study. A comprehensive search strategy was used across multiple databases, including PubMed, EMBASE, Web of Science, Scopus, and CINAHL. The search focused on studies published between 2019 and 2024, specifically targeting adult patients in the ICU. Studies focusing on pediatric populations, patients with mental illnesses, or those investigating ulcers unrelated to MDRPIs were excluded. After screening and selecting relevant studies, data were extracted and analyzed in numerical data. The review included 35 studies, revealing a high prevalence of MDRPIs in ICU settings, ranging from 5.01% to 62.4% across various countries. The prevalence was related to several factors, such as patient demographics (age and comorbidities), ICU practices, and the type and duration of medical device usage. Mechanical ventilation, nasogastric tubes, and endotracheal tubes were among the most common devices associated with MDRPIs. Tailored interventions, such as regular skin assessments and pressure-redistributing devices, are crucial for preventing MDRPIs and improving patient outcomes. The COVID-19 pandemic experience emphasizes the need for vigilant monitoring and evidence-based preventive measures in critical care environments.

Exhaled end-tidal carbon dioxide (EtCO2) trajectory is associated with out-of-hospital cardiac arrest (OHCA) outcomes. However, the minimum EtCO2 monitoring duration needed to discriminate return of spontaneous circulation (ROSC) from non-ROSC remains unknown. We sought to determine the EtCO2 trajectory observation time required to differentiate ROSC from non-ROSC patients. We performed a secondary analysis of the cluster-randomized Pragmatic Airway Resuscitation Trial (PART), which assessed endotracheal intubation or laryngeal tube strategies in OHCA resuscitation. We summarized mean EtCO2 in 1-minute epochs over the resuscitation. Cases were stratified a priori by: (1) witnessed versus unwitnessed status, and (2) initial EtCO2: low (≤30 mm Hg), moderate (31-49), and high (≥50). Within each stratum, group-based trajectory modeling (GBTM) was used to identify latent EtCO2 trajectory classes, and patients were categorized into an upward or downward trajectory. To balance trajectory groups on baseline characteristics including age, sex, race, initial rhythm, location, and bystander CPR, we applied inverse probability of treatment weighting. We fit weighted pooled logistic regression models to estimate risk ratios (RRs) for ROSC comparing upward versus downward EtCO2 trajectories. Within each stratum, we identified the earliest minute when CIs between upward versus downward EtCO2 trajectories no longer overlapped. EtCO2 data were available for 1168 patients: 452 (38.6%) witnessed and 716 (61.1%) unwitnessed. Patients were predominantly men (63.5%), with a median age of 65 years (Q1, Q3: 53-75), majority White race (51.3%), and presenting in a nonpublic setting (85.4%). Overall ROSC was 18.2%: 30.5% of witnessed and 10.5% of unwitnessed. Among witnessed arrests, 95% CI for upward versus downward EtCO2 trajectories no longer overlapped at 8 minutes for low initial EtCO2 (RR, 3.06; 95% CI, 1.49, 6.71), 12 minutes for moderate EtCO2 (RR, 1.95; 95% CI, 1.23, 3.48), and 21 minutes for high EtCO2 (RR, 2.12; 95% CI, 1.30, 3.73). Among unwitnessed arrests, nonoverlapping CIs were first observed at 7 minutes (RR, 3.56; 95% CI, 1.53, 10.37). Depending on witness status and initial EtCO2, between 7 and 21 minutes of monitoring are needed to reliably differentiate upward from downward EtCO2 trajectories during OHCA resuscitation. Dynamic EtCO2 trajectory monitoring may provide early prognostic information to guide resuscitation.

Gestational psittacosis is a rare but severe zoonotic infection caused by Chlamydia psittaci. This systematic review aims to evaluate the clinical characteristics, diagnostic challenges, therapeutic interventions, and maternal-fetal outcomes of this condition. A systematic search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang Data from inception to October 31, 2025. Two investigators independently performed study selection and data extraction encompassing maternal demographics, clinical manifestations, laboratory findings, diagnostic modalities, antimicrobial regimens, and maternal-fetal outcomes. A total of 32 cases from 30 publications were included. The median maternal age was 29 years (IQR: 26-32), and the median gestational age at diagnosis was 26.5 weeks (IQR: 21-30). All patients presented with fever (32/32, 100%), and common symptoms included headache (17/32, 53%), cough (15/32, 47%), and dyspnea (15/32, 47%). Severe disease was frequent: 66% (21/32) required intensive care unit (ICU) admission, 34% (11/32) required endotracheal intubation, and maternal mortality was 13% (4/32). Thrombocytopenia (26/32, 81%), hepatic dysfunction (27/32, 84%), renal impairment (18/32, 56%), and disseminated intravascular coagulation (DIC) (15/32, 47%) were the most prominent laboratory abnormalities. Diagnostic approaches evolved from serology to molecular methods. Recent studies have demonstrated the potential value of metagenomic next-generation sequencing (mNGS) in diagnosis, but further research is needed to confirm its clinical utility. The overall fetal and neonatal mortality was 68% (21/31 with available data), primarily due to stillbirth, spontaneous abortion, or therapeutic induction. These estimates reflect outcomes among reported cases and may overestimate true population-level risk. Gestational psittacosis is a rare but life-threatening infection associated with substantial maternal morbidity and a high risk of fetal loss, although these outcomes may be influenced by publication bias. mNGS has facilitated earlier diagnosis in recent case reports; however, comparative performance data for gestational psittacosis remain limited. PROSPERO, CRD420251275911 (Registered 30 December 2025). Not applicable.

Optimizing dry powder delivery during invasive mechanical ventilation via circuit absolute humidity control.

Objective: Laryngoscopy and endotracheal intubation during laparoscopic surgery elicit haemodynamic surges, risking cardiovascular complications. Intravenous lignocaine and labetalol are used to attenuate these responses, but comparative efficacy remains debated. Methods: This prospective, randomised, double-blind study involved 100 ASA I/II patients (aged 18-60 years) undergoing elective laparoscopic cholecystectomy. Patients were allocated to Group I (lignocaine 1.5 mg/kg IV, 2 min pre-intubation+saline 5 min pre) or Group II (labetalol 0.15 mg/kg IV, 5 min pre-intubation+saline 2 min pre). Haemodynamics (heart rate [HR], systolic [SBP], diastolic [DBP], mean arterial pressure [MAP]) were recorded at baseline (T0), pre-induction (Tp), intubation (Ti), post-intubation (T1 min, T3 min), every 5 min (T5 min-T40 min), pneumoperitoneum (Tpneumo), and end-of-surgery (Teos). Data analysed using t-test/Mann-Whitney U; p&lt;0.05 significant. Results: Demographics were comparable (age: 41.68±11.23 vs 41.12±12.14 y, p=0.811; weight: 65.46±6.83 vs 61.50±10.83 kg, p=0.087). Labetalol better attenuated responses: At Ti, HR (83.72±7.06 vs 91.08±10.78 bpm, p=0.001), SBP (120.04±5.07 vs 131.74±6.98 mmHg, p=0.001), DBP (76.00±3.96 vs 75.96±6.86 mmHg, p=0.972), MAP (90.68±4.25 vs 94.55±7.32 mmHg, p=0.001). Similar superiority at T1, T10, Tpneumo, T40, Teos (all p&lt;0.01). Lignocaine showed transient control at Tp but higher surges later (Teos HR: 111.42±9.50 vs 84.96±7.19 bpm, p=0.001). No adverse events reported. Conclusion: Intravenous labetalol (0.15 mg/kg) is superior to lignocaine (1.5 mg/kg) in attenuating haemodynamic responses during laparoscopic surgery, offering sustained stability and enhanced safety for at-risk patients.

Systematic Review of Pediatric Ketamine in Emergency Department Procedural Sedation: Frequency and Predictors of Adverse Events.

Airway management is a critical priority for HEMS teams, as failure to secure the airway remains a major determinant of mortality and long-term disability. The present study was designed to evaluate the variability of advanced airway management devices and medications availability across all HEMS units in Italy. In addition, crew composition and specialty training of HEMS personnel were assessed. As a whole, this survey aims at highlighting areas for improvement of airway management during HEMS operations. This observational cross-sectional study was carried out between May and September 2024. A web-based questionnaire was distributed to all active HEMS bases in Italy. The questionnaire consisted of two main sections: Section A addressed the availability of basic and advanced airway management equipment and medications, whereas Section B focused on crew characteristics, including number, role, experience, and training. A composite index to capture "airway preparedness"(API) was designed based on Difficult Airway Society 2025 guidelines. Selected items were assigned a weighted value and the final score ranged 0-40. Of 55 active HEMS bases, 48 completed the questionnaire (response rate: 87%). Manual ventilation devices, a direct laryngoscope, a complete set of Macintosh adult blades, an end-tidal CO₂ monitoring device, and supraglottic airway devices were consistently available. A videolaryngoscope was present in most bases (39, 81%). Either surgical or Seldinger cricothyroidotomy kits were present in 94%. Medications for rapid sequence intubation were universally available, although sugammadex was stocked in only 36 bases (75%). A physician was present in all surveyed units (100%). However, specific training in airway management was not provided in 37 bases (77%), and 44% did not require a minimum number of prior endotracheal intubations for new personnel. Only 13 bases (27%) reported the adoption of airway management guidelines for prehospital care. The mean ± SD national API was 25.7 ± 7.4, ranging from a regional mean of 37 ± 1.4 to a regional mean of 11.2 ± 5.3. The study demonstrated substantial heterogeneity in equipment, personnel background, and training across Italian HEMS bases. Although only few bases reported adherence to specific guidelines, the devices and medications recommended in the literature for the management of unexpected difficult airways were widely available.