Every year, the hopeless task of keeping up with the medical literature grows even more unattainable. Will our Sisyphean burden be replaced with AI? (Read this month’s Skeptics’ Guide to Emergency Medicine for that answer.) Will we be microchipped with peripheral PubMed brains? Will we finally wake up from the Matrix and be freed? Not yet!

So, in the meantime, here’s a host of articles of more than just passing interest from the past year, not already covered in ACEP Now.

New Developments in Forced Air

A few years ago, the vogue debate was rocuronium versus succinylcholine. Then, it was video laryngoscopy versus direct … bougie or stylet. Now, the next debate to be settled is the ideal method for preoxygenation before intubation. The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units.¹ The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent. The obvious winner was NIPPV, whose 9.1 percent incidence of hypoxemia was half that of the oxygen mask cohort. Serious patient-oriented outcomes such as cardiac arrest were rare, but almost all occurred in the oxygen mask cohort. As such, it’s fair to say, whenever conditions allow, pre-oxygenation with positive-pressure ventilation (PPV) is likely superior.

The HAPPEN trial is another one with results that may be worth watching.² This was not an ED trial but was performed in stable patients on the inpatient wards. This trial tested “high-intensity” PPV in patients with type II respiratory failure due to exacerbations of chronic obstructive pulmonary disease. With study results and outcomes best described as “complicated,” the high-intensity PPV improved physiologic normalization of respiratory parameters and decreased need for endotracheal intubation, as compared with typical NIPPV. It remains to be seen whether higher inspiratory pressures find their way into future trials of ED bilevel positive airway pressure ventilation.

Sepsis Robots or Sepsis Humans

The proliferation of “sepsis” alerts in the ED has reached levels best described as “obscene.” The common refrain from trained clinicians: We are smarter than any computer or simple scoring system, and we can rapidly and accurately identify sepsis by ourselves, thank you very much. The claim has obvious face validity, but supporting evidence is always welcome. In a prospective study comparing clinician gestalt against systemic inflammatory response syndrome, Sequential Organ Failure Assessment (SOFA), quick SOFA, Modified Early Warning Score (MEWS), and a logistic regression machine learning model using Least Absolute Shrinkage and Selection Operator (LASSO), the obvious winner was the clinician.³ The machine learning model trailed just behind. My fellow humans, enjoy what may be our short-lived superiority over the robots.