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The tracheal tube introducer (known as the bougie) is used primarily for patients with poor laryngeal views or as a rescue device when initial intubation attempts fail. In a randomized clinical trial of 757 patients requiring emergency orotracheal intubation, Driver and colleagues found that use of a bougie, compared with an endotracheal tube and stylet, was more likely to achieve intubation on the first attempt.
Oxygenation of Extremely Preterm Infants
Oxygen therapy is essential for the treatment of many preterm infants, but too much oxygen can be toxic. Askie and colleagues for the Neonatal Oxygenation Prospective Meta-analysis Collaboration conducted a meta-analysis of 5 trials that randomized 4965 extremely preterm infants to higher or lower target ranges for oxygen saturation and found no difference in death or major disability. In an Editorial, Bizzarro discusses secondary outcomes of the treatment strategies.
Identifying Patients at Risk of Sepsis
The quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score may be useful in resource-limited settings because it is not based on laboratory tests. Rudd and colleagues for the Sepsis Assessment and Identification in Low Resource Settings Collaboration conducted a retrospective analysis of hospitalized adults with suspected infection in 9 cohorts from low- and middle-income countries and found that the qSOFA score had predictive validity for identifying patients at risk of death. In an Editorial, Adhikari and Rubenfeld discuss the qSOFA score as a screening test for sepsis.
Bioengineered Tracheal and Bronchial Reconstruction
Airway replacement could restore function to patients with proximal lung tumors or end-stage tracheobronchial disease. Martinod and colleagues analyzed the clinical experience of 20 patients and found airway reconstruction with a human cryopreserved aortic allograft to be feasible, although further research is needed to assess efficacy and safety. In an Editorial, Rusch suggests that future studies could explore the mechanisms of tissue regeneration and help refine this novel procedure.
Related Article and Editorial
Video and Author Audio Interview, CME
Clinical Review & Education
Restricted Randomization in Clinical Trials
In trials with small sample sizes, randomization procedures can be modified to ensure that participants or prespecified covariates are balanced across study groups. Broglio discusses the advantages and disadvantages of restricted randomization techniques in this JAMA Guide to Statistics and Methods.
Hearing Aids and Quality of Life
Hearing loss is a barrier to communication and social engagement. In this Clinical Evidence Synopsis summarizing a Cochrane review of 5 randomized clinical trials, Kitterick and Ferguson discuss the benefits of hearing aids for patients with hearing loss.
Evaluation and Management of Patients With Suspected Syncope
In this JAMA Clinical Guidelines Synopsis of a 2017 guideline developed by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society, Waytz and colleagues discuss the evaluation of adults with suspected syncope and the need for more research to guide the management of patients at intermediate risk of adverse outcomes.
Highlights. JAMA. 2018;319(21):2149–2151. doi:10.1001/jama.2017.12394
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