Posts (144)

Fri, Feb 2 10:23am · Intravenous Lidocaine for pain in the ED: what the evidence shows?

Author: Lucas Oliveira J. e Silva (@lucasojesilva12)


Lidocaine is a local anesthetic agent of the amide type that has been described as containing analgesic (1), anti-hyperalgesic (2) and anti-inflammatory properties (3,4). It has a short half-life (60 to 120 minutes) and its side effects are often predictable. Due to its short half-life, toxicity symptoms at lower doses are generally transient, although its analgesic effect might last more than expected (5). Lidocaine for pain control, administered by intravenous (IV) injection, has been studied in various settings, including the operating room for management of perioperative pain (5) and outpatient clinics for treatment of neuropathic pain. Its use in the Emergency Department (ED), however, has only recently gained attention after emerging evidence for the management of pain of renal colic patients in the ED (6,7).


The current public health crisis of opioid addiction driven by increased prescribing of these medications, and increased number of overdose-related deaths, further emphasizes the need for alternative approaches for pain control.


In order to better understand the whole body of evidence, we conducted a systematic review to evaluate the safety and efficacy of IV lidocaine for adult patients undergoing pain management in the ED through the outcomes of reduction in pain scores, need for rescue analgesia, and incidence of adverse drug reactions.


Here the link to the paper (Annals of EM):


We found 1947 titles and abstracts and 61 potentially relevant studies were identified. After full-text review, a total of 8 studies met our inclusion criteria. Standard guidelines for systematic reviews were followed (PRISMA and GRADE). Qualitative analysis was done for all studies, and a meta-analysis was not possible given the low quality and significant clinical heterogeneity across the studies.


We found that the value of intravenous lidocaine as an analgesic modality and option for pain relief in the ED is promising, but yet to be determined. Four of six randomized controlled trials found comparable or superior reduction in pain scores using IV lidocaine when compared to active controls (ie: morphine). Lidocaine appeared to be effective in patients with renal colic and critical limb ischemia, and did not appear to be beneficial for migraine headaches.

The evidence for safety of IV lidocaine in the ED is also limited, with only 6 studies reporting the adverse drug reactions. One case-series reported a cardiac arrest secondary to the use of the wrong dose of IV lidocaine in the ED.


Main findings (Table 2 of the paper):


Outcome Effect Number of studies Certainty in the evidence
Reduction in pain scores Only 2 trials found significant reduction and most trials, especially for renal colic pain, failed to compare to standard of care and typical medications. 6 randomized controlled trials and 2 case-series VERY LOW ⨁◯◯◯

(due to methodological limitations, imprecision and inconsistency)

Need for rescue analgesia Most studies did not describe in detail which agent or doses were used after the use of IV lidocaine and controls. 5 randomized controlled trials and 2 case-series VERY LOW ⨁◯◯◯

(due to methodological limitations, imprecision and inconsistency)

Incidence of adverse events 20 adverse events reported across the studies, being 19 non-serious and 1 serious. 4 randomized controlled trials and 2 case-series VERY LOW ⨁◯◯◯

(due to methodological limitations, imprecision, inconsistency and potential publication bias)


In summary, this systematic review found limited evidence to support the efficacy and safety of IV lidocaine as a single agent and/or as an adjunct to other parenteral analgesics for short-term pain relief in the ED. Intravenous lidocaine may be effective for conditions like visceral, neuropathic and ischemic pain. Further well-designed studies are needed to address the role of IV lidocaine for different causes of pain in the ED, the most appropriate dose and timing for administration, and confirm its safety in different age groups and clinical populations.


Bottom-line: Although promising, the current body of evidence is limited and intravenous lidocaine for pain management needs further well-designed studies to determine its safety and efficacy before the routine use for analgesia in the ED.


Link to article



  1. Lauretti GR. Mechanisms of analgesia of intravenous lidocaine. Rev Bras Anestesiol. 2008;58:280-286.
  2. Koppert W, Ostermeier N, Sittl R, Weidner C, Schmelz M. Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain. 2000;85:217-224.
  3. Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology. 2000;93:858-875.
  4. van der Wal SE, van den Heuvel SA, Radema SA, et al. The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain. Eur J Pain. 2016;20:655-674.
  5. Dunn LK, Durieux ME. Perioperative Use of Intravenous Lidocaine. Anesthesiology. 2017;126:729-737.
  6. Firouzian A, Alipour A, Rashidian Dezfouli H, et al. Does lidocaine as an adjuvant to morphine improve pain relief in patients presenting to the ED with acute renal colic? A double-blind, randomized controlled trial. Am J Emerg Med. 2016;34:443-448.
  7. Soleimanpour H, Hassanzadeh K, Vaezi H, Golzari SE, Esfanjani RM, Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. 2012;12:13.


Dec 20, 2017 · Thomas R. Hellmich M.D., named new chair of Emergency Medicine at Mayo Clinic Rochester


Thomas R. Hellmich, M.D. has been named the new chair of the Department of Emergency Medicine at Mayo Clinic Rochester. Dr. Hellmich follows Annie T. Sadosty, M.D. who recently became the Mayo Clinic Health System Vice president for Southeast Minnesota.

Thomas Hellmich, M.D., is a Pediatric Emergency Medicine physician, Assistant Professor in Emergency Medicine and Pediatrics at Mayo Clinic Hospital – Rochester (MN).  He attended DePauw University and received a B.A. degree in Zoology. He then attended Indiana University School of Medicine and completed his residency and fellowship at the Children’s Hospital of Wisconsin.  In 2004, he received a MBA in Health Care Management from the University of St. Thomas.  His past leadership roles at Children’s Hospital and Clinics in Minneapolis, MN include Pediatric Emergency Medicine Fellowship Director, Medical Director of Simulation Program, Medical Director of Emergency Services and Chief of Staff. In 2012, he joined Mayo Clinic and serves as the Medical Director of Mayo Clinic’s first Clinical Engineering Learning Laboratory. His interests include physician leadership, quality, and health system engineering.

Dec 18, 2017 · Better informed consent in the ED: going through the research to practice continuum

Author: Lucas Oliveira J. e Silva (@lucasojesilva12)

Few years ago when consenting patients for procedural sedation in the Emergency Department (ED), we realized that the risks were unclear and communicating those risks to the patients was a challenge.

To solve the problem of risk communication, we knew that knowing the evidence would not be enough, however the first step would be find the best information available regarding the adverse events of procedural sedation in the ED. We looked at the literature and one study was not enough, meaning that a summary of the evidence was needed to make the large amount of information comprehensible for clinicians and patients. Two years later, we published two systematic reviews and meta-analyses (1, 2) evaluating the risks of performing procedural sedation in the ED among both the pediatric and adult populations. However, despite having summarized the literature, we found ourselves empty handed when communicating with patients. We were not filling the gap and improving the communication process, which was the main reason we spent two years working on the systematic reviews. In a 5-step framework (Figure 1) of the research to practice continuum, we were clogged in a gap between the best evidence available and good informed consent in the ED (step 4 of the framework, Figure 1).

Figure 1. 5-step framework of the research to practice continuum.

In the last few years, constant efforts have been made to put together the Evidence-Based Medicine core concepts with translation of evidence into practice, especially in terms of patient-centered perspectives (3). The need for more knowledge translation has emerged essentially from a gap between what is known from high-quality evidence and what is consistently done in clinical practice (4).

Systematic reviews offer multiple benefits but are often written in technical language, are long, and do not contain contextual details, making them hard to translate into practice (5). After the two publications, we then decided to ask for help of implementation scientists, patient education specialists, nurses, providers, caregivers, patients and professional designers, to transform the meta-analyses information into a visual aid tool (step 5 of the framework, Figure 1). An evidence-based visual aid tool was developed to help the translation of complex numbers into meaningful and straightforward information.

Here the link to the paper (open access!): link to the paper here

In this study, we described how we went through the research to practice continuum in order to better translate our research findings to the bedside. Publishing and disseminating research findings with its large amount of information are not enough within this continuum, and efforts should be made to better translate the evidence into practice. The problem of risk communication before informed consent for procedural sedation could not be solved only finding the best evidence available.

Bottom-line: The research to practice continuum in EM can go above the expectations of researchers, and efforts should be made to implement and translate the evidence into practice, taking into consideration that evidence users, including both clinicians and patients, may benefit from easy and straightforward visual aid tools for translation of research findings.


FULL-ARTICLE: (open access)



  1. Bellolio MF, Gilani WI, Barrionuevo P, et al. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department: A Systematic Review and Meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2016;23:119-134.
  2. Bellolio MF, Puls HA, Anderson JL, et al. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis. BMJ open. 2016;6:e011384.
  3. Lang E. Finding One’s Way In Translating Evidence Into Practice. Annals of Emergency Medicine.51:791-792.
  4. Lang ES, Wyer PC, Eskin B. Executive summary: Knowledge translation in emergency medicine: establishing a research agenda and guide map for evidence uptake. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2007;14:915-918.
  5. Rowe BH, Wyer PC, Cordell WH. Evidence-based emergency medicine. Improving the dissemination of systematic reviews in emergency medicine. Annals of  Emergency Medicine. 2002 Mar;39(3):293-5.


Oct 12, 2017 · Social Media Scholarship as a Criterion for Academic Promotion

This is crosspost from the Mayo Clinic Social Media network. Below a video with our webinar on Social Media and Academic Promotion.

Oct 5, 2017 · Mayo Clinic EM in ACEP 2017


Sunday, October 29

3-3:50 p.m.

133 (Infomatics)

Measuring Radio-Frequency Identification Sensitivity and Precision in the Emergency Department: A Method for Clinically Relevant Assessment of Real-Time Location Services

Karalius VP, Nestler DM, Koenig KR, Hawthorne HJ, Hellmich TR, Pasupathy KS, Heaton HA


134 (Infomatics)

Characterization of Emergency Department Abandonment Using Real-Time Location System

Pasupathy K, Heaton H, Nestler D, Lovik K, Sadosty A, Finley J, Thompson K, Hellmich T, Sir M, Huschka T, Marisamy G


4-4:50 p.m.

137 (Administration/Practice Management)

Optimal Scheduling: Using Technology to Drive a Workload-Based Scheduling Model for Emergency Department Pharmacists

Rudis MI, Wutthisirisart P, Heaton HA, Pasupathy KS, Sir MY, Hellmich TR


141 (Administration/Practice Management)

Frequency and Effect of Interruptions on Resident Workload in the Emergency Department

Jones DD, Forsyth KL, Hawthorne HJ, El-Sherif N, Varghese RS, Runkle T, Sunga K,

Hellmich TR, Blocker RC



Monday, October 30

11-11:50 a.m.

234 (Pain Management)

Safety and Efficacy of Intravenous Lidocaine for Pain Management in the Emergency Department: A Systematic Review and Meta-Analysis

e Silva LOJ, Scherber K, Cabrera D, Motov S, West CP, Murad MH, Bellolio MF


12 noon-1 p.m.

EMF 2 (EMF Showcase Luncheon)

The Acute Otitis Media Decision Aid: Pathway to Shared Decisionmaking

Anderson JL, Hess EP, Brito Campana JP, Hargraves IG


Tuesday, October 31

10-10:50 a.m.

365 (Ultrasound)

Detecting Pericardial Effusions: Is One View Enough?

Corcoran J, Kane G, Muruganandan M, Liebmann O, Leo M, Nichols M, Kummer T


389 (Quality and Patient Safety)

My Visit Board: Improving Patient Understanding of Emergency Department Care

Funk E, Kummer T, Friedrich C, Lohse C, Heaton H

Sep 26, 2017 · The ED does not hand out opioids like candy

Author: Molly M. Jeffery, PhD @mollyjeffery

Everyone “knows” they hand out opioids like candy in the ED.  Or if they don’t now, they certainly used to.


That idea didn’t square with the clinical experience of any of the ED doctors I’ve talked to. We wanted to know what the clinical reality is across the country, so we used the OptumLabs Data Warehouse to look at opioid prescribing for acute pain in the ED and other settings. OLDW has a huge dataset of insurance claims covering millions of people over 20+ years. We looked at data from 2009-2015, focusing on people who were opioid naïve (no opioid fills in the past 6 months) and who did not have cancer and were not in hospice.  We converted all the prescriptions into mg of morphine equivalents (MME) to have a common unit of measure across drugs.


We compared the ED to other settings on how often prescriptions aligned with best practices for acute opioid prescribing on days supplied, daily dose, and opioid formulation (long-acting vs. immediate release). Then we followed people to find out whether they continued to use opioids after that initial prescription. (We used the CONSORT definition of chronic opioid use: an episode lasting 90+ calendar days and including either 10 fills or 120+ days supply.)


The CDC recommends []  acute prescriptions should be for less than 7 days supply, but less than 3 days is better.  There is little guidance on the best starting dose, but the CDC recommends that chronic opioid users (who have built up some tolerance) remain below 90 MME, but below 50 MME is safer. Finally, the CDC says opioid treatment should start with immediate release opioids; extended release/long-acting formulations are generally dangerous for opioid naïve people.


In brief, the results of our study was that prescriptions written in the ED were more likely to meet each of the measures of safe prescribing than prescriptions written in other settings: they were shorter and for lower doses, and they were more likely to be immediate-release. And patients receiving their prescription in the ED were less likely to continue to use opioids.


These weren’t small differences. You can check out the paper for full results, but as an example, among the commercially insured, 3.1% of prescriptions written in the ED exceeded 7 days vs. 19.1% written in non-ED settings; 14.3% of prescriptions written in the ED exceeded 50 MME per day vs. 22.8% of prescriptions written in non-ED settings. (With a sample size of >5.2 million prescriptions, all of these differences are statistically significant at any conventional level.)


And patients receiving prescriptions written in the ED were 46% to 58% less likely to continue using opioids chronically than those seen in non-ED settings.


ED physicians will probably not be surprised by our findings, but they may be surprising to other physicians and policymakers. We checked whether this pattern has changed over time. It hasn’t; the ED was better than non-ED settings across the whole study period.


I would guess that some non-ED physicians will argue that the patients seen in the ED are so different that this isn’t a fair comparison. It’s true that patients don’t randomly decide whether to show up at the ED or another setting (like primary care or surgeons office) for treatment of their pain. We address some of this difference by limiting our population to people who are not currently taking prescription opioids and excluded cancer and hospice patients—in nearly all these cases, the recommended opioid treatment regimen is the same: a short course of opioids at a low dose.


Furthermore, we found that in all treatment settings, patients receiving prescriptions that met all our measures were less likely to continue to use opioids. The differences were huge in the non-ED setting: the risk of continued use was about 4 times higher with prescriptions that didn’t meet the measures vs. those written in the same setting that did meet the measures.


We hope that this research will be helpful to physicians and patients deciding how to treat acute pain. The characteristics of your first opioid prescription are strongly associated with your risk of continuing to use opioids long term. Given the suffering caused by opioid misuse and addiction, I think many people may be willing to try non-opioid treatments for their pain to reduce their risk of long term opioid use. Although a small number of people may eventually need opioids, avoiding opioids as a first line of treatment for acute pain makes a lot of sense.



Jul 19, 2017 · How to best identify patients that have a high likelihood of dying in one year?

Author: Caitlin Loprinzi-Brauer, MD @cloprinzi

To determine who should have goals of care discussions, encourage advanced care planning and consider palliative medicine consultation


Cardiopulmonary resuscitation (CPR) is the only medical intervention that does not need consent to be preformed. In medicine all patients are assumed to be a full code and undergo CPR and most times intubation (insertion of a breathing tube), unless otherwise documented. For many having all interventions preformed in attempt to save their life is what they want and what would be recommended by most medical professionals. As patients age or have a decline in their health secondary to medical comorbidities, many patients do not want aggressive heroic measures taken, particularly in times of critical illness. Also, as people age and medial comorbidities increase, the likelihood of survival following cardiac arrest decreases.

Value-based decision-making is about eliciting a patient’s values and goals in order to guide treatment; however, patients are not always empowered or able to communicate their wishes. Advance healthcare directives (AHD) can help patients communicate their wishes regarding their care and can guide conversations with surrogate decision-makers when the patient lacks capacity for such discussions. Understanding patients’ goals and values is especially important in the case of critically ill patients presenting to the emergency department (ED) who would receive life-sustaining treatments unless this is not what the patient wants.


We externally validated and derived a clinical prediction tool previously created by an ED group in Australia (Richardson P et al. We identified patients likely to die within one-year;, as these patients ideally should have advanced care planning (i.e. completed an advanced directive or similar document) including their code status documented (ie, Do not resuscitate or Do not intubate).

The PREDICT screening tool is composed by six variables that are easy to collect within a clinical ED visit and is easy to utilize in the fast-paced environment of the ED. Each criterion is assigned different points as seen in the table below:

PREDICT criteria and score

Feature Points
Referral to palliative care team for a non-cancer diagnosis 12
Current residence in nursing home 3
Department of intensive care unit (ICU) admission with multi-organ failure 10
Current diagnosis of cancer 10
2 medical admissions in the past year 3
Age at ED visit in years
   55-65 1
   66-75 2
   76 3


In our study, we applied the PREDICT tool to 927 patients older than 55 years of age presenting to the ED. A fourth of them (26%) were deceased at one year. Patients from the deceased group were older, had a higher PREDICT score, had an increased number of comorbidities, were more likely to live in a nursing home, and were more likely to have an AHD on file. Of the 147 patients with PREDICT scores ≥13, 55% were deceased at one year. The AUC of the PREDICT score was 0.717, sensitivity 33% and specificity was 90% to predict 1-year mortality. High specificity is preferred in this scenario, however a table with different sensitivity and specificity and ROC curves depending on the PREDICT score cutoff used are presented in the full article.


We further refined the clinical prediction tool to improve the original PREDICT criteria, and the PREDICT minus ICU admission with multiorgan failure (modified PREDICT) appeared to have a diagnostic test accuracy performance similar to the original PREDICT score. We selected this as the preferred model, as the variable of ICU admission with multiorgan failure is not always available at the time of assessment in the ED, was the hardest one to extract from the records, and will make the model easier to apply earlier in the course of an ED visit. By removing the ICU admission variable, this clinical tool, could result in earlier calculation of the PREDICT score during an ED visit. This time could be used for initiating conversations regarding AHD and, if appropriate, allow placement of palliative care consultation before inpatient admission.


PREDICT and modified PREDICT have advantages over other prognostic indices. Other indices require a patient be assessed for factors not regularly gathered in the context of a brief clinical encounter in the ED setting, require the use of the complex non-cancer hospice guidelines that may not be familiar to those who work outside of hospice and palliative medicine, incorporate laboratory values that may not be available or up-to-date, cannot be applied until the patient has final disposition from the ED, or cannot be applied to patients until they are dismissed from the hospital. PREDICT and modified PREDICT use data commonly available in the medical record or that are clinically relevant to an ED physician and are generally collected within the confines of a clinical encounter in the ED. Further, either PREDICT score could be discussed directly with the patient and their caregivers while they are in the ED and, thus, AHD, goals-of-care discussions and, when applicable, the need for palliative care consultation can be identified earlier and, possibly, initiated before the patient is admitted to the hospital.

Link to the paper



  • Moman RN, Loprinzi Brauer CE, Kelsey KM, Havyer RD, Lohse CM, Bellolio MF. PREDICTing Mortality in the Emergency Department: External Validation and Derivation of a Clinical Prediction Tool. Acad Emerg Med. 2017 Jul;24(7):822-831. doi: 10.1111/acem.13197. Epub 2017 May 29. PubMed PMID: 2840162

Jul 15, 2017 · Apneic Oxygenation actually works (for some things)


Author: Lucas Silva (@lucasojesilva12)


In the last few years, the use of apneic oxygenation has been recommended by experts for management of high-risk airway situations, including emergency intubations in the ED (1), and for patients at risk for difficult laryngoscopy and intubation in the operating room (2).

The relative simplicity and safety of this intervention and the potential to turn intubation in a safer procedure, with higher success rates and fewer complications, led to a rapid and widespread use of the concept and to its even being considered by some as standard of care despite relatively scarce evidence to support its use (1). Recently, ICU-based studies have shown conflicting results on the effectiveness of apneic oxygenation using different approaches (3-8).

To evaluate the current evidence, we performed a systematic review and meta-analysis on the use of apneic oxygenation during emergency intubation (ED or ICU intubations), looking at outcomes as hypoxemia, first-pass success, and lowest oxygen saturation.  

Here the link to the paper (open access!):


After a comprehensive literature search, including 4 large databases, we found 1,386 studies for review. After screening the titles and abstracts and removing duplicates, we identified 77 potentially relevant studies. After full-text review, a total of 14 studies met the inclusion criteria: 6 ICU studies, 6 ED studies, and 2 mixed ED and ICU studies. The included studies involved 2,023 participants, with 1,168 patients receiving apneic oxygenation during intubation and 855 not receiving it. Eight studies including 982 patients receiving apneic oxygenation and 855 not receiving it, underwent meta-analysis.

In this study, we found that the use of apneic oxygenation during emergency intubation appears to be associated with increased peri-intubation oxygen saturation and first-pass success rates, as well as decreased incidence of hypoxemia in patients intubated in the ED or ICU. The use of apneic oxygenation was associated with a decrease in ICU length of stay, but there was no difference in duration of mechanical ventilation and ICU mortality. We found no reports of adverse events related to the use of apneic oxygenation, despite different approaches and settings.


Main findings:

  • Hypoxemia (SpO2 < 93%)
    • Meta-analysis of 8 studies, 1837 patients;
    • Odds ratio (OR) 0.66; 95% confidence interval (CI) 0.52 to 0.84.
  • First-Pass Success (success on the first attempt of laryngoscopy)
    • Meta-analysis of 6 studies, 1658 patients;
    • OR 1.59; 95% CI 1.04 to 2.44.
  • Lowest Oxygen Saturation Peri-Intubation
    • Meta-analysis of 6 studies, 1043 patients;
    • Weighted Mean Difference +2.2%; 95% CI 0.8% to 3.6%.


Limitations regarding our study, however, have to be acknowledged. The major limitation relates to the quality of included studies, which warrants a moderate to low level of certainty in the estimates. Another important limitation is the different approaches used to apneic oxygenation in terms of preoxygenation and other peri-intubation variables and co-interventions. The different methods of preoxygenation between groups could affect the likelihood of developing hypoxemia during the apneic period; therefore, the effect of apneic oxygenation was not isolated in some of the included studies. The maintenance of airway patency during apneic oxygenation was not described in most of the studies, and that might affect the quality of this intervention. The clinical heterogeneity of patients intubated in the ED and ICU in regard to their cardiorespiratory baseline status is also an important factor to be considered, and which approach is better among the spectrum of sickness in patients requiring emergency intubation still has to be evaluated by future studies.

In summary, in our meta-analysis apneic oxygenation was associated with increased peri-intubation SpO2, decreased hypoxemia, and increased first-pass intubation success.


Bottom-line: The current body of evidence supports the role of apneic oxygenation as an important adjunct for emergency airway management.


FULL-ARTICLE: (open access)



  1. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59:165-175.e161.
  2. Berkow L, Hagberg CA, Crowley M. Airway management for induction of general anesthesia. In: Post TWU, Waltham MA, eds. UpToDate.
  3. Besnier E, Guernon K, Bubenheim M, et al. Pre-oxygenation with high-flow nasal cannula oxygen therapy and non-invasive ventilation for intubation in the intensive care unit. Intensive Care Med. 2016;42:1291-1292.
  4. Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42:1877-1887.
  5. Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574-583.
  6. Semler MW, Janz DR, Lentz RJ, et al. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. Am J Respir Crit Care Med. 2016;193:273-280.
  7. Simon M, Wachs C, Braune S, et al. High-flow nasal cannula versus bag-valve-mask for preoxygenation before intubation in subjects with hypoxemic respiratory failure. Respir Care. 2016;61:1160-1167.
  8. Vourc’h M, Asfar P, Volteau C, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41:1538-1548.


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