Respiratory Trials·org

Topic

Procedures

Bronchoscopy, intubation, tracheostomy, and vascular access.

Intubation has been substantially rebuilt around the minutes before the laryngoscope. Preoxygenating with non-invasive ventilation halved hypoxaemia, from 18.5% to 9.1% (PREOXI), and bag-mask ventilating between induction and laryngoscopy raised saturations without causing aspiration (PreVent) — overturning rapid-sequence dogma. Video laryngoscopy improved first-attempt success enough to stop its trial early (DEVICE). The induction agent, by contrast, does not matter: ketamine and etomidate gave identical mortality (Ketamine or etomidate).

For vascular access, subclavian lines carry fewer infections and clots and more pneumothoraces than jugular or femoral (3SITES) — pick the site by which complication the patient can least afford. Withholding prophylactic platelets before insertion in thrombocytopenic patients failed non-inferiority (PACER), so that practice stays.

Two small procedural details with outsized effects: aspirin does not need stopping before transbronchial biopsy (Herth 2002), and sending 10 mL of pleural fluid for cytology misses malignancy that 60 mL would find (Swiderek 2010).

Preoxygenation before intubation

Trial Year Therapy Effect Finding
PREOXI 2024 Non-invasive ventilation for preoxygenation Preoxygenating with non-invasive ventilation halved hypoxaemia during intubation
PreVent (bag-mask) 2019 Bag-mask ventilation between induction and laryngoscopy Bag-mask ventilating between induction and laryngoscopy raised saturations without causing aspiration

Bleeding risk at bronchoscopy

Trial Year Therapy Effect Finding
Herth 2002 prospective cohort 2002 Continuing aspirin Aspirin did not increase bleeding after transbronchial biopsy

How much pleural fluid to send

Trial Year Therapy Effect Finding
Swiderek 2010 diagnostic accuracy 2010 Larger-volume pleural fluid sampling Sending 10 mL of pleural fluid misses malignancy that 60 mL would find

Induction agent for intubation

Trial Year Therapy Effect Finding
Ketamine or etomidate 2026 Ketamine Ketamine and etomidate produced identical mortality at intubation

Intubation technique

Trial Year Therapy Effect Finding
DEVICE 2023 Video laryngoscopy Video laryngoscopy improved first-attempt intubation success enough to stop the trial early

Platelets before central line insertion

Trial Year Therapy Effect Finding
PACER 2023 Withholding prophylactic platelet transfusion Skipping prophylactic platelets before a central line caused more bleeding

Where to site a central line

Trial Year Therapy Effect Finding
3SITES 2015 Subclavian vein catheterisation Subclavian lines had fewer infections and clots but more pneumothoraces

Key references

Guidelines, standards and reviews for this topic.