human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions . Mental stress , ignorance of the patient 's medical history , potential cervical injury or immobilisation and the presence of vomit and /or blood may also contribute to a difficult airway . Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management . OBJECTIVE The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting . DESIGN A r and omised clinical trial . SETTING Emergency Department of the University Hospital , Zurich , Switzerl and . PATIENTS With approval of the local ethics committee , we prospect ively enrolled 150 patients between 18 and 99 years of age requiring emergency rapid sequence intubation in the emergency room of the University Hospital Zurich . Patients were r and omised ( 1 : 1 ) to undergo tracheal intubation using the C-MAC videolaryngoscope or by direct laryngoscopy . INTERVENTIONS Owing to ethical considerations , patients who had sustained maxillo-facial trauma , immobilised cervical spine , known difficult airway or ongoing cardiopulmonary resuscitation were excluded from our study . All intubations were performed by one of three very experienced anaesthesia consultants . MAIN OUTCOME MEASURES First-attempt success rate served as our primary outcome parameter . Secondary outcome parameters were time to intubation ; total number of intubation attempts ; Cormack and Lehane score ; inadvertent oesophageal intubation ; ease of intubation ; complications including violations of the teeth , injury/bleeding of the larynx/pharynx and aspiration/regurgitation of gastric contents ; necessity of using further alternative airway devices for successful intubation ; maximum decrease of oxygen saturation and technical problems with the device . RESULTS A total of 150 patients were enrolled , but three patients had to be excluded from the analysis , result ing in 74 patients in the C-MAC videolaryngoscopy group and 73 patients in the direct laryngoscopy group . Tracheal intubation was achieved successfully at the first attempt in 73 of 74 patients in the C-MAC group and all patients in the direct laryngoscopy group ( P = 1.0 ) . Time to intubation was similar ( 32 ± 11 vs. 31 ± 9 s , P = 0.51 ) in both groups . Visualisation of the vocal cords , represented as the Cormack and Lehane score , was significantly better using the C-MAC videolaryngoscope ( P < 0.001 ) . CONCLUSION Our study demonstrates that visualisation of the vocal cords was improved by using the C-MAC videolaryngoscope compared with direct laryngoscopy . Better visualisation did not improve first-attempt success rate , which in turn was probably based on the high level of experience of the participating anaesthesia consultants . TRIAL REGISTRATION Clinical trials.gov identifier NCT02297113 RATIONALE Hypoxemia is common during endotracheal intubation of critically ill patients and may predispose to cardiac arrest and death . Administration of supplemental oxygen during laryngoscopy ( apneic oxygenation ) may prevent hypoxemia . OBJECTIVES To determine if apneic oxygenation increases the lowest arterial oxygen saturation experienced by patients undergoing endotracheal intubation in the intensive care unit . METHODS This was a r and omized , open-label , pragmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit were r and omized to receive 15 L/min of 100 % oxygen via high-flow nasal cannula during laryngoscopy ( apneic oxygenation ) or no supplemental oxygen during laryngoscopy ( usual care ) . The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after completion of endotracheal intubation . MEASUREMENTS AND MAIN RESULTS Median lowest arterial oxygen saturation was 92 % with apneic oxygenation versus 90 % with usual care ( 95 % confidence interval for the difference , -1.6 to 7.4 % ; P = 0.16 ) . There was no difference between apneic oxygenation and usual care in incidence of oxygen saturation less than 90 % ( 44.7 vs. 47.2 % ; P = 0.87 ) , oxygen saturation less than 80 % ( 15.8 vs. 25.0 % ; P = 0.22 ) , or decrease in oxygen saturation greater than 3 % ( 53.9 vs. 55.6 % ; P = 0.87 ) . Duration of mechanical ventilation , intensive care unit length of stay , and in-hospital mortality were similar between study groups . CONCLUSIONS Apneic oxygenation does not seem to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared with usual care . These findings do not support routine use of apneic oxygenation during endotracheal intubation of critically ill adults . Clinical trial registered with www . clinical trials.gov ( NCT 02051816 ) Objective To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit ( ICU ) . Design Two-phase , prospect i ve , multicenter controlled study . Setting Three medical-surgical ICUs in two university hospitals . Patients Two hundred three consecutive ICU patients required 244 intubations . Interventions All intubations performed during two consecutive phases ( a 6-month quality control phase followed by a 6-month intervention phase based on the implementation of an ICU intubation bundle management protocol ) were evaluated . The ten bundle components were : preoxygenation with noninvasive positive pressure ventilation , presence of two operators , rapid sequence induction , cricoid pressure , capnography , protective ventilation , fluid loading , preparation and early administration of sedation and vasopressor use if needed . Measurements and main results The primary end points were the incidence of life-threatening complications occurring within 60 min after intubation ( cardiac arrest or death , severe cardiovascular collapse and hypoxemia ) . Other complications ( mild to moderate ) were also evaluated . Baseline characteristics , including demographic data and reason for intubation ( mainly acute respiratory failure ) , were similar in the two phases . The intubation procedure in the intervention phase ( n = 121 ) was associated with significant decreases in both life-threatening complications ( 21 vs. 34 % , p = 0.03 ) and other complications ( 9 vs. 21 % , p = 0.01 ) compared to the control phase ( n = 123 ) . Conclusions The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients BACKGROUND : Hypoxemia is the most common complication during endotracheal intubation of critically ill adults .  Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation , but has never been studied outside of the operating room . METHODS : Multicenter , r and omized trial comparing the ramped position ( head of the bed elevated to 25 ° ) with the sniffing position ( torso supine , neck flexed , and head extended ) among 260 adults undergoing endotracheal intubation by pulmonary and critical care medicine fellows in four ICUs between July 22 , 2015 , and July 19 , 2016 . The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after intubation . Secondary outcomes included Cormack‐Lehane grade of glottic view , difficulty of intubation , and number of laryngoscopy attempts . RESULTS : The median lowest arterial oxygen saturation was 93 % ( interquartile range [ IQR ] , 84%‐99 % ) with the ramped position vs 92 % ( IQR , 79%‐98 % ) with the sniffing position ( P = .27 ) . The ramped position appeared to increase the incidence of grade III or IV view ( 25.4 % vs 11.5 % , P = .01 ) , increase the incidence of difficult intubation ( 12.3 % vs 4.6 % , P = .04 ) , and decrease the rate of intubation on the first attempt ( 76.2 % vs 85.4 % , P = .02 ) , respectively . CONCLUSIONS : In this multicenter trial , the ramped position did not improve oxygenation during endotracheal intubation of critically ill adults compared with the sniffing position . The ramped position may worsen glottic view and increase the number of laryngoscopy attempts required for successful intubation . TRIAL REGISTRY : Clinical Trials.gov ; No. : NCT02497729 ; URL : www . clinical BACKGROUND : Hypoxemia and hypotension are common complications during endotracheal intubation of critically ill adults . Verbal performance of a written , preintubation checklist may prevent these complications . We compared a written , verbally performed , preintubation checklist with usual care regarding lowest arterial oxygen saturation or lowest systolic BP experienced by critically ill adults undergoing endotracheal intubation . METHODS : A multicenter trial in which 262 adults undergoing endotracheal intubation were r and omized to a written , verbally performed , preintubation checklist ( checklist ) or no preintubation checklist ( usual care ) . The co primary outcomes were lowest arterial oxygen saturation and lowest systolic BP between the time of procedural medication administration and 2 min after endotracheal intubation . RESULTS : The median lowest arterial oxygen saturation was 92 % ( interquartile range [ IQR ] , 79‐98 ) in the checklist group vs 93 % ( IQR , 84‐100 ) with usual care ( P = .34 ) . The median lowest systolic BP was 112 mm Hg ( IQR , 94‐133 ) in the checklist group vs 108 mm Hg ( IQR , 90‐132 ) in the usual care group ( P = .61 ) . There was no difference between the checklist and usual care in procedure duration ( 120 vs 118 s ; P = .49 ) , number of laryngoscopy attempts ( one vs one attempt ; P = .42 ) , or severe life‐threatening procedural complications ( 40.8 % vs 32.6 % ; P = .20 ) . CONCLUSIONS : The verbal performance of a written , preprocedure checklist does not increase the lowest arterial oxygen saturation or lowest systolic BP during endotracheal intubation of critically ill adults compared with usual care . TRIAL REGISTRY : Clinical Trials.gov ; No. : NCT02497729 ; URL : www . clinical trials.gov AIM This study compared endotracheal intubation ( ETI ) performance during cardiopulmonary resuscitation ( CPR ) between  direct laryngoscopy ( DL ) and video laryngoscopy ( VL ) ( GlideScope ( ® ) ) by experienced intubators ( > 50 successful ETIs ) . METHODS This was a prospect i ve r and omized controlled study conducted in an emergency department between 2011 and 2013 . Intubators who used DL or VL were r and omly allocated to ETI during CPR . Data were collected from recorded video clips and rhythm sheets . The success , speed , complications , and chest compressions interruption were compared between the two devices . RESULTS Total 140 ETIs by experienced intubators using DL ( n=69 ) and VL ( n=71 ) were analysed . There were no significant differences between DL and VL in the ETI success rate ( 92.8 % vs. 95.8 % ; p=0.490 ) , first-attempt success rate ( 87.0 % vs. 94.4 % ; p=0.204 ) , and median time to complete ETI ( 51 [ 36 - 67 ] vs. 42 [34 - 62]s ; p=0.143 ) . In both groups , oesophageal intubation and dental injuries seldom occurred . However , longer chest compressions interruption occurred using DL ( 4.0 [1.0 - 11.0]s ) compared with VL ( 0.0 [0.0 - 1.0]s ) and frequent serious no-flow ( interruption>10s ) occurred with DL ( 18/69 [ 26.1 % ] ) compared with VL ( 0/71 ) ( p<0.001 ) . For highly experienced intubators ( > 80 successful ETIs ) , frequent serious no-flow occurred in DL ( 14/55 [ 25.5 % ] vs. 0/57 in VL ) . CONCLUSIONS The ETI success , speed and complications during CPR did not differ significantly between the two devices for experienced intubators . However , the VL was superior in terms of completion of ETI without chest compression interruptions . TRIAL REGISTRATION Clinical Research Information Service ( CRIS ) in South Korea KCT0000849 Background : Class III obese patients have altered respiratory mechanics , which are further impaired in the supine position 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions . Mental stress , ignorance of the patient 's medical history , potential cervical injury or immobilisation and the presence of vomit and /or blood may also contribute to a difficult airway . Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management . OBJECTIVE The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting . DESIGN A r and omised clinical trial . SETTING Emergency Department of the University Hospital , Zurich , Switzerl and . PATIENTS With approval of the local ethics committee , we prospect ively enrolled 150 patients between 18 and 99 years of age requiring emergency rapid sequence intubation in the emergency room of the University Hospital Zurich . Patients were r and omised ( 1 : 1 ) to undergo tracheal intubation using the C-MAC videolaryngoscope or by direct laryngoscopy . INTERVENTIONS Owing to ethical considerations , patients who had sustained maxillo-facial trauma , immobilised cervical spine , known difficult airway or ongoing cardiopulmonary resuscitation were excluded from our study . All intubations were performed by one of three very experienced anaesthesia consultants . MAIN OUTCOME MEASURES First-attempt success rate served as our primary outcome parameter . Secondary outcome parameters were time to intubation ; total number of intubation attempts ; Cormack and Lehane score ; inadvertent oesophageal intubation ; ease of intubation ; complications including violations of the teeth , injury/bleeding of the larynx/pharynx and aspiration/regurgitation of gastric contents ; necessity of using further alternative airway devices for successful intubation ; maximum decrease of oxygen saturation and technical problems with the device . RESULTS A total of 150 patients were enrolled , but three patients had to be excluded from the analysis , result ing in 74 patients in the C-MAC videolaryngoscopy group and 73 patients in the direct laryngoscopy group . Tracheal intubation was achieved successfully at the first attempt in 73 of 74 patients in the C-MAC group and all patients in the direct laryngoscopy group ( P = 1.0 ) . Time to intubation was similar ( 32 ± 11 vs. 31 ± 9 s , P = 0.51 ) in both groups . Visualisation of the vocal cords , represented as the Cormack and Lehane score , was significantly better using the C-MAC videolaryngoscope ( P < 0.001 ) . CONCLUSION Our study demonstrates that visualisation of the vocal cords was improved by using the C-MAC videolaryngoscope compared with direct laryngoscopy . Better visualisation did not improve first-attempt success rate , which in turn was probably based on the high level of experience of the participating anaesthesia consultants . TRIAL REGISTRATION Clinical trials.gov identifier NCT02297113 RATIONALE Hypoxemia is common during endotracheal intubation of critically ill patients and may predispose to cardiac arrest and death . Administration of supplemental oxygen during laryngoscopy ( apneic oxygenation ) may prevent hypoxemia . OBJECTIVES To determine if apneic oxygenation increases the lowest arterial oxygen saturation experienced by patients undergoing endotracheal intubation in the intensive care unit . METHODS This was a r and omized , open-label , pragmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit were r and omized to receive 15 L/min of 100 % oxygen via high-flow nasal cannula during laryngoscopy ( apneic oxygenation ) or no supplemental oxygen during laryngoscopy ( usual care ) . The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after completion of endotracheal intubation . MEASUREMENTS AND MAIN RESULTS Median lowest arterial oxygen saturation was 92 % with apneic oxygenation versus 90 % with usual care ( 95 % confidence interval for the difference , -1.6 to 7.4 % ; P = 0.16 ) . There was no difference between apneic oxygenation and usual care in incidence of oxygen saturation less than 90 % ( 44.7 vs. 47.2 % ; P = 0.87 ) , oxygen saturation less than 80 % ( 15.8 vs. 25.0 % ; P = 0.22 ) , or decrease in oxygen saturation greater than 3 % ( 53.9 vs. 55.6 % ; P = 0.87 ) . Duration of mechanical ventilation , intensive care unit length of stay , and in-hospital mortality were similar between study groups . CONCLUSIONS Apneic oxygenation does not seem to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared with usual care . These findings do not support routine use of apneic oxygenation during endotracheal intubation of critically ill adults . Clinical trial registered with www . clinical trials.gov ( NCT 02051816 ) Objective To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit ( ICU ) . Design Two-phase , prospect i ve , multicenter controlled study . Setting Three medical-surgical ICUs in two university hospitals . Patients Two hundred three consecutive ICU patients required 244 intubations . Interventions All intubations performed during two consecutive phases ( a 6-month quality control phase followed by a 6-month intervention phase based on the implementation of an ICU intubation bundle management protocol ) were evaluated . The ten bundle components were : preoxygenation with noninvasive positive pressure ventilation , presence of two operators , rapid sequence induction , cricoid pressure , capnography , protective ventilation , fluid loading , preparation and early administration of sedation and vasopressor use if needed . Measurements and main results The primary end points were the incidence of life-threatening complications occurring within 60 min after intubation ( cardiac arrest or death , severe cardiovascular collapse and hypoxemia ) . Other complications ( mild to moderate ) were also evaluated . Baseline characteristics , including demographic data and reason for intubation ( mainly acute respiratory failure ) , were similar in the two phases . The intubation procedure in the intervention phase ( n = 121 ) was associated with significant decreases in both life-threatening complications ( 21 vs. 34 % , p = 0.03 ) and other complications ( 9 vs. 21 % , p = 0.01 ) compared to the control phase ( n = 123 ) . Conclusions The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients BACKGROUND : Hypoxemia is the most common complication during endotracheal intubation of critically ill adults .  Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation , but has never been studied outside of the operating room . METHODS : Multicenter , r and omized trial comparing the ramped position ( head of the bed elevated to 25 ° ) with the sniffing position ( torso supine , neck flexed , and head extended ) among 260 adults undergoing endotracheal intubation by pulmonary and critical care medicine fellows in four ICUs between July 22 , 2015 , and July 19 , 2016 . The primary outcome was lowest arterial oxygen saturation between induction and 2 minutes after intubation . Secondary outcomes included Cormack‐Lehane grade of glottic view , difficulty of intubation , and number of laryngoscopy attempts . RESULTS : The median lowest arterial oxygen saturation was 93 % ( interquartile range [ IQR ] , 84%‐99 % ) with the ramped position vs 92 % ( IQR , 79%‐98 % ) with the sniffing position ( P = .27 ) . The ramped position appeared to increase the incidence of grade III or IV view ( 25.4 % vs 11.5 % , P = .01 ) , increase the incidence of difficult intubation ( 12.3 % vs 4.6 % , P = .04 ) , and decrease the rate of intubation on the first attempt ( 76.2 % vs 85.4 % , P = .02 ) , respectively . CONCLUSIONS : In this multicenter trial , the ramped position did not improve oxygenation during endotracheal intubation of critically ill adults compared with the sniffing position . The ramped position may worsen glottic view and increase the number of laryngoscopy attempts required for successful intubation . TRIAL REGISTRY : Clinical Trials.gov ; No. : NCT02497729 ; URL : www . clinical BACKGROUND : Hypoxemia and hypotension are common complications during endotracheal intubation of critically ill adults . Verbal performance of a written , preintubation checklist may prevent these complications . We compared a written , verbally performed , preintubation checklist with usual care regarding lowest arterial oxygen saturation or lowest systolic BP experienced by critically ill adults undergoing endotracheal intubation . METHODS : A multicenter trial in which 262 adults undergoing endotracheal intubation were r and omized to a written , verbally performed , preintubation checklist ( checklist ) or no preintubation checklist ( usual care ) . The co primary outcomes were lowest arterial oxygen saturation and lowest systolic BP between the time of procedural medication administration and 2 min after endotracheal intubation . RESULTS : The median lowest arterial oxygen saturation was 92 % ( interquartile range [ IQR ] , 79‐98 ) in the checklist group vs 93 % ( IQR , 84‐100 ) with usual care ( P = .34 ) . The median lowest systolic BP was 112 mm Hg ( IQR , 94‐133 ) in the checklist group vs 108 mm Hg ( IQR , 90‐132 ) in the usual care group ( P = .61 ) . There was no difference between the checklist and usual care in procedure duration ( 120 vs 118 s ; P = .49 ) , number of laryngoscopy attempts ( one vs one attempt ; P = .42 ) , or severe life‐threatening procedural complications ( 40.8 % vs 32.6 % ; P = .20 ) . CONCLUSIONS : The verbal performance of a written , preprocedure checklist does not increase the lowest arterial oxygen saturation or lowest systolic BP during endotracheal intubation of critically ill adults compared with usual care . TRIAL REGISTRY : Clinical Trials.gov ; No. : NCT02497729 ; URL : www . clinical trials.gov AIM This study compared endotracheal intubation ( ETI ) performance during cardiopulmonary resuscitation ( CPR ) between  direct laryngoscopy ( DL ) and video laryngoscopy ( VL ) ( GlideScope ( ® ) ) by experienced intubators ( > 50 successful ETIs ) . METHODS This was a prospect i ve r and omized controlled study conducted in an emergency department between 2011 and 2013 . Intubators who used DL or VL were r and omly allocated to ETI during CPR . Data were collected from recorded video clips and rhythm sheets . The success , speed , complications , and chest compressions interruption were compared between the two devices . RESULTS Total 140 ETIs by experienced intubators using DL ( n=69 ) and VL ( n=71 ) were analysed . There were no significant differences between DL and VL in the ETI success rate ( 92.8 % vs. 95.8 % ; p=0.490 ) , first-attempt success rate ( 87.0 % vs. 94.4 % ; p=0.204 ) , and median time to complete ETI ( 51 [ 36 - 67 ] vs. 42 [34 - 62]s ; p=0.143 ) . In both groups , oesophageal intubation and dental injuries seldom occurred . However , longer chest compressions interruption occurred using DL ( 4.0 [1.0 - 11.0]s ) compared with VL ( 0.0 [0.0 - 1.0]s ) and frequent serious no-flow ( interruption>10s ) occurred with DL ( 18/69 [ 26.1 % ] ) compared with VL ( 0/71 ) ( p<0.001 ) . For highly experienced intubators ( > 80 successful ETIs ) , frequent serious no-flow occurred in DL ( 14/55 [ 25.5 % ] vs. 0/57 in VL ) . CONCLUSIONS The ETI success , speed and complications during CPR did not differ significantly between the two devices for experienced intubators . However , the VL was superior in terms of completion of ETI without chest compression interruptions . TRIAL REGISTRATION Clinical Research Information Service ( CRIS ) in South Korea KCT0000849 Background : Class III obese patients have altered respiratory mechanics , which are further impaired in the supine position 
    Output:
    