Thread by @PulmCrit

Weingart on hemodynamic assassination due to intubation
- preintubation hypotension = primary risk factor
- primary physiology = loss of catechols & transition from negative to positive pressure (reduces preload)
- @emcrit at #HRreloaded

Protective pathway for intubation
- separate out dissociation vs. paralysis
- 1st titrate ketamine to unawareness (ensures adequate dose but not too much)
- 2nd paralyze with high dose (2 mg/kg roc!) - ensures rapid onset
- @emcrit at #HRreloaded

Hemodynamically *neutral* path avoids rapid transition from negative --> positive pressure
- Purest form = awake intubation
- Addition of ketamine may facilitate in agitated pt
- Bronchoscopic intubation may involve least stimulation
- @emcrit at #HRreloaded

Hemodynamically neutral pathway 2/3 - key is after intubation do *not* put paralyze & place them on positive pressure ventilation. Allow patient to continue breathing on their own! Ongoing negative-pressure ventilation on the ventilator 🤯
- @emcrit at #HRreloaded

Hemodynamically neutral pathway 3/3 - Drawback of not providing vent support is that patient is doing the work of breathing. So as the patient stabilizes over time, you may *gradually* up-titrate the amount of positive pressure and ventilator support.
- @emcrit at #HRreloaded