Week In Review: 10/10/21

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Melina Alexander
St. Vincent's Emergency Medicine Resident, PGY-1

For some spaced repetition, here’s a review of this week’s content:

Maximizing Decarboxylation in ARDS by Aman Thind

  • Addressing decarboxylation can be a major issue in patient with ARDS where alveolar dead space is often increased.
  • In the early stage of severe ARDS where maximizing lung protection is of paramount importance, strategies that enhance decarboxylation allow minimization of tidal volume.
  • Post-inspiratory pause is an underappreciated technique that can independently augment decarboxylation for a given amount of alveolar ventilation.

Should We Still Be Using Ketofol? by Rachel Rafeq

  • The ideal agent for procedural sedation should exhibit the rapid onset of action, duration of action long enough to sustain the procedure but short enough to allow for quick recovery, and minimal to no adverse effects.
  • In theory, combining propofol with ketamine would be ideal since propofol provides amnestic and sedating properties, while ketamine provides analgesia and preservation of respiratory function. However, the literature has not been able to demonstrate a clear win for the combination compared to single-agent use. 
  • If using ketofol, lower doses of each component (e.g. 1 mg/kg ketamine and propofol in equal ratios or less) may be reasonable without compromising efficacy.

Iron Age or New Age? by Sabrina Kroft

  • BCV utilizes negative pressure in various modes to improve lung function.
  • BCV has been shown to decrease respiratory muscle fatigue while improving minute ventilation
  • BCV has been shown to improve cardiac output and decrease mPA

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