Description
We obsess over the paralytic, but are we giving enough of it?
In this episode of PRISM Rounds, we review a new AJRCCM secondary analysis of 1,822 critically ill adults from the DEVICE and PREOXI trials examining whether rocuronium dose is associated with first-attempt intubation success.
Patients receiving more than 1.2 mg/kg had higher first-attempt success overall, with the strongest signal in ICU patients. But rocuronium dose was chosen by clinicians rather than randomized, so residual confounding matters.
We break down the study, the accompanying editorial, the pharmacologic rationale for higher dosing, the ICU versus ED findings, and the key bedside question: Should this change how we dose rocuronium during emergency intubation?
Original article:
https://academic.oup.com/ajrccm/article/212/8/1740/8679093
Accompanying editorial:
https://academic.oup.com/ajrccm/article/212/8/1680/8706698
Educational use only. This is not medical advice.
Tags
Critical Care, ICU, Airway Management, Tracheal Intubation, Emergency Intubation, Rocuronium, Neuromuscular Blockade, Rapid Sequence Intubation, RSI, First Pass Success, First Attempt Success, Video Laryngoscopy, DEVICE Trial, PREOXI Trial, AJRCCM, Pulmonary Critical Care, Emergency Medicine, Anesthesiology, Evidence Based Medicine, Journal Club, Medical Education, PRISM Rounds
