Coverage: Oct 26, 2026 through Nov 1, 2026 · America/Los_Angeles
Sample weekly digest containing all three historical articles added to EM Weekly this week. These studies are from 2023–2024; this is a format preview, not a current literature review.
AT A GLANCE
Clinical Takeaways
PREOXI: NIV preoxygenation reduced peri-intubation hypoxemia compared with an oxygen mask in selected critically ill adults.
DEVICE: Video laryngoscopy increased first-attempt success in critically ill adults; operator experience and setting affect applicability.
CLOVERS: A restrictive fluid strategy with earlier vasopressors did not significantly reduce mortality compared with liberal fluids in sepsis-induced hypotension.
Practice-Changing / High Priority
Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension
New England Journal of Medicine - Jan 21, 2023
Summary
CLOVERS randomized 1,563 adults after initial fluid resuscitation to a restrictive strategy prioritizing vasopressors or a liberal fluid strategy. Death before discharge home by day 90 occurred in 14.0% versus 14.9% (difference -0.9 percentage points; 95% CI -4.4 to 2.6; P=0.61).
Why it matters
The trial did not demonstrate a mortality advantage for either strategy after initial fluids; it does not resolve management before resuscitation.
Limitations
Unblinded and stopped for futility. Patients had already received 1-3 L; results do not establish equivalence or apply to all shock states.
Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults
New England Journal of Medicine - Jun 16, 2023
Summary
In 1,417 critically ill adults, video laryngoscopy achieved first-pass success in 85.1% versus 70.8% with direct laryngoscopy (difference 14.3 percentage points; 95% CI 9.9 to 18.7). Severe complications occurred in 21.4% versus 20.9% (difference 0.5 points; 95% CI -3.9 to 4.9).
Why it matters
Video laryngoscopy improved first-pass success in ED and ICU intubations, largely performed by trainees; complication benefit was not demonstrated.
Limitations
Stopped early for efficacy. Most operators were residents or fellows, limiting generalization to experienced operators.
Noninvasive Ventilation for Preoxygenation during Emergency Intubation
New England Journal of Medicine - Jun 13, 2024
Summary
PREOXI randomized 1,301 critically ill adults to NIV or an oxygen mask before intubation. Hypoxemia (SpO2 <85%) occurred in 9.1% versus 18.5% (absolute difference -9.4 percentage points; 95% CI -13.2 to -5.6).
Why it matters
Supports choosing NIV for preoxygenation in suitable critically ill adults to reduce peri-intubation hypoxemia. This studied regimen does not establish a survival benefit.
Limitations
Unblinded trial in US EDs and ICUs. Applicability depends on patient suitability for NIV; infrequent safety events do not establish equivalence.
Abstract-based summary; methods text also checked for design. Open-access full text available for further appraisal. AI-generated · Not yet human-reviewed.
Published on EM Weekly Oct 26, 2026. Selection prioritizes potential ED impact and methodological strength. Automated ranking is an editorial aid, not a definitive judgment of clinical importance.
AI-generated · Not yet human-reviewed · Read the primary source and apply clinical judgment.