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BIPAP IPAP: Higher is Better?

EM Literature of Note

In this unblinded, randomized-controlled trial, patients with acute exacerbations of COPD received traditional NIPPV with inspiratory pressures <18 cmH20 or “high-intensity” NIPPV, with airway pressures titrated up to 20-30 cmH20. This trial, the HAPPEN trial, looks at a little bit different approach. in each group.

COPD 93
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The Latest in Critical Care, 9/28/23 (Issue #15)

PulmCCM

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia? About two thirds of patients in each arm were vaccinated.

COPD 95
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SGEM#447: Just What I Needed – Preoxygenation Prior To Intubation

The Skeptics' Guide to EM

Case: A 70-year-old man presents to the emergency department (ED) with an exacerbation of COPD. They do not provide positive pressure or ventilatory support, and the actual FiO2 delivered can be significantly lower than expected if the mask does not fit well. He is hypoxic on arrival with an oxygen saturation of 80% on room air.

COPD 91
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BPAP vs AVAPS for Hypercapnic Respiratory Failure in the ED

RebelEM

AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20

COPD 133
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Serial PoCUS for ED Patients with Acute Dyspnea: Is More Actually Better?

RebelEM

It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3]. Patients : Compared standard of care to serial US plus stand care in patients with dyspnea.

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TAME Trial: Mild Hypercapnia vs Normocapnia in Out-of-Hospital Cardiac Arrest

RebelEM

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.

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A Brilliant Comment Makes the Study of the Week

Sensible Medicine

This is a common probably insurmountable problem with morbidities, such as hypertension, diabetes , COPD , etc. In these cases, not only is the diagnosis completely arbitrary on the part of the clinician, but the severity of the condition has an extremely strong influence on its contribution to the usually measured outcome.