Late-preterm resuscitation: starting at 30% oxygen did not change the primary outcome, but fewer babies needed escalation

The edition in brief

In the AIROPLANE cluster-randomised crossover trial at 26 Australian maternity hospitals, starting delivery-room respiratory support with 30% rather than 21% oxygen in 1,818 newborns born at 32–35 weeks did not change the proportion still on respiratory support when leaving the delivery room (72.6% vs 73.3%). Two of 12 secondary outcomes favoured 30%: less escalation of delivery-room support, including compressions or adrenaline (proportional OR 0.70), and less endotracheal ventilation after the delivery room (6.4% vs 9.3%). A systematic review of AI- and machine-learning-assisted emergency triage found high pooled discrimination for critical illness in four adult studies (AUC 0.874) but very high heterogeneity, weak calibration reporting and little external validation; modelling suggested fewer missed critical cases at the cost of more false escalations. In a pooled analysis of 3,848 ventilated patients without ARDS at the start, neurocritical patients received lower tidal volumes and PEEP yet developed ARDS more often (8.7% vs 3.9%), with lower ICU mortality. The pearl covers setting tidal volume by predicted body weight and keeping carbon dioxide controlled in brain injury.