Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study.
ABSTRACT To describe the current practice of physicians, to report complications associated with endotracheal intubation (ETI) performed in THE intensive care unit (ICU), and to isolate predictive factors of immediate life-threatening complications.
Multiple-center observational study.
Seven intensive care units of two university hospitals.
: We evaluated 253 occurrences of ETI in 220 patients.
From January 1 to June 30, 2003, data related to all ETI performed in ICU were collected. Information regarding patient descriptors, procedures, and immediate complications were analyzed.
The main indications to intubate the trachea were acute respiratory failure, shock, and coma. Some 148 ETIs (59%) were performed by residents. At least one severe complication occurred in 71 ETIs (28%): severe hypoxemia (26%), hemodynamic collapse (25%), and cardiac arrest (2%). The other complications were difficult intubation (12%), cardiac arrhythmia (10%), esophageal intubation (5%), and aspiration (2%). Presence of acute respiratory failure and the presence of shock as an indication for ETI were identified as independent risk factors for occurrence of complications, and ETI performed by a junior physician supervised by a senior (i.e., two operators) was identified as a protective factor for the occurrence of complications.
ETI in ICU patients is associated with a high rate of immediate and severe life-threatening complications. Independent risk factors of complication occurrence were presence of acute respiratory failure and presence of shock as an indication for ETI. Further studies should aim to better define protocols for intubation in critically ill patients to make this procedure safer.
Article: Preventing severe hypoxia during emergent intubation: is nasopharyngeal oxygenation the answer?[show abstract] [hide abstract]
ABSTRACT: Critically ill patients requiring emergent endotracheal intubation are at risk for life-threatening hypoxemia during the intubation procedure, particularly when the patient is apneic and not receiving any supplemental oxygen. In a current study, Engström and colleagues investigated the effect of nasopharyngeal oxygenation in eight anesthetized pigs with induced acute lung injury. The investigators confirmed, even in this model, that pharyngeal oxygenation significantly prolonged the time to desaturation during periods of apnea. Recognizing the limitations of directly extrapolating these experimental results to critically ill human subjects, the findings do support the contention that, until proven otherwise, nasopharyngeal oxygenation should at least be considered as one technique to diminish hypoxemic complications in very sick patients, particularly those with underlying pulmonary impairment.Critical care (London, England) 11/2010; 14(6):1005. · 4.61 Impact Factor
Article: 3,423 emergency tracheal intubations at a university hospital: airway outcomes and complications.[show abstract] [hide abstract]
ABSTRACT: There are limited outcome data regarding emergent nonoperative intubation. The current study was undertaken with a large observational dataset to evaluate the incidence of difficult intubation and complication rates and to determine predictors of complications in this setting. Adult nonoperating room emergent intubations at our tertiary care institution from December 5, 2001 to July 6, 2009 were reviewed. Prospectively defined data points included time of day, location, attending physician presence, number of attempts, direct laryngoscopy view, adjuvant use, medications, and complications. At our institution, a senior resident with at least 24 months of anesthesia training is the first responder for all emergent airway requests. The primary outcome was a composite airway complication variable that included aspiration, esophageal intubation, dental injury, or pneumothorax. A total of 3,423 emergent nonoperating room airway management cases were identified. The incidence of difficult intubation was 10.3%. Complications occurred in 4.2%: aspiration, 2.8%; esophageal intubation, 1.3%; dental injury, 0.2%; and pneumothorax, 0.1%. A bougie introducer was used in 12.4% of cases. Among 2,284 intubations performed by residents, independent predictors of the composite complication outcome were as follows: three or more intubation attempts (odds ratio, 6.7; 95% CI, 3.2-14.2), grade III or IV view (odds ratio, 1.9; 95% CI, 1.1-3.5), general care floor location (odds ratio, 1.9; 95% CI, 1.2-3.0), and emergency department location (odds ratio, 4.7; 95% CI, 1.1-20.4). During emergent nonoperative intubation, specific clinical situations are associated with an increased risk of airway complication and may provide a starting point for allocation of experienced first responders.Anesthesiology 01/2011; 114(1):42-8. · 5.36 Impact Factor
Journal of Tehran University Heart Center 11/2011; 6(4):220-3.