Airway Management in Critical Illness

Walz, J. Matthias; Zayaruzny, Maksim; Heard, Stephen O.

doi:10.1378/chest.06-2120

Cited by 116 publications

(63 citation statements)

References 100 publications

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“…[1][2][3][4] These patients often require immediate resuscitation, which may result in a suboptimal intubation condition. 5 Accordingly, the incidence of adverse events associated with EETI is high in comparison with elective endotracheal intubation performed in the operating theatre.…”

Section: Ré Sumémentioning

confidence: 99%

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Green

Hutton

Lorette

et al. 2014

CJEM

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Objective: Hemodynamic instability following emergent endotracheal intubation (EETI) is a potentially life-threatening adverse event. The objectives of this systematic literature review were to document the incidence of postintubation hemodynamic instability (PIHI), to determine the definitions for PIHI used in the available literature, and to examine factors associated with PIHI in adult patients who require EETI. Data Source: Articles published in Medline (1966-August 2012. Study Selection: This systematic review included adult, inhospital studies of EETIs. Studies with nonemergent or pediatric patient populations were excluded. Data Extraction: Two authors independently performed data abstraction. Disagreements were resolved by a third party. The methodological quality of included studies was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. Data Synthesis: We estimated the pooled prevalence of PIHI across studies using a random effects meta-analysis. Subgroups analyzed included study design, intubation setting, geographic location of the study, physician experience, medications used for sedation, neuromuscular blockade, and definition of PIHI. Eighteen studies were analyzed, with sample sizes from 84 to 2,833 patients. The incidence of PIHI ranged from 5 to 440 cases per 1,000 intubations, with a pooled estimate of 110 cases per 1,000 intubations (95% CI 65-167). Conclusions: PIHI was found to occur in 110 cases per 1,000 in-hospital, emergent intubations. However, heterogeneity among the included studies limits the reliability of this summary estimate. Further investigation is warranted. RÉ SUMÉObjectifs: L'instabilité hé modynamique consé cutive à une intubation endotraché ale trè s urgente (IETU) est un é vé nement indé sirable potentiellement mortel. L'examen mé thodique de la documentation avait pour objectifs d'é tablir la fré quence de l'instabilité hé modynamique aprè s intubation (IHAI), de dé terminer les dé finitions de l'IHAI utilisé es dans la documentation et d'examiner les facteurs associé s à l'IHAI chez les adultes. Source de donné es: Les articles publié s dans Medline (1966-aoû t 2012) ont constitué la source de donné es. Sé lection des é tudes: L'examen mé thodique portait sur les é tudes ayant pour objet les IETU effectué es chez les adultes, en milieu hospitalier; les é tudes portant sur les intubations non considé ré es comme trè s urgentes ou effectué es chez les enfants é taient é carté es. Extraction des donné es: Deux auteurs ont procé dé , chacun de leur cô té , aux ré sumé s analytiques des donné es. Les divergences de point de vue ont é té ré solues par une tierce partie. La qualité mé thodologique des é tudes retenues a é té é valué e selon l'é chelle de NewcastleOttawa, qui permet d'é valuer la qualité des é tudes de cohortes. Synthè se des donné es: L'estimation de la pré valence globale de l'IHAI, tiré e des é tudes retenues repose sur une mé taanalyse à effets alé atoires. Ont é té analysé s le type d'é tude, le service où ont é té eff...

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Section: Ré Sumémentioning

confidence: 99%

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Green

Hutton

Lorette

et al. 2014

CJEM

View full text Add to dashboard Cite

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“…The primary responder (typically a nurse, junior doctor or allied health professional) needs to be guided to detect airway problems, to assess tracheostomy and airway patency and to provide basic emergency oxygenation. The secondary responder (typically an anaesthetist, intensivist, head and neck surgeon or specialist practitioner) will have skills in conventional airway management and will also be guided to use skills in managing the tracheostomy or stoma [53]. These skills could include difficult oral/nasal intubation techniques, the ability to use a fibreoptic 'scope to assess or replace tracheostomy tubes and the ability to perform and manage an emergency surgical airway or tracheostomy.…”

Section: Results: the Guidelinesmentioning

confidence: 99%

“…This is due to numerous factors including a reduction in the number of difficult airways that present late, shorter working hours, better airway equipment, increased use of supraglottic airways and a reduction in training opportunities [54,59,[128][129][130][131][132][133][134]. It is essential that frontline medical, nursing and allied health staff are competent to manage and assist with tracheostomy and other related airway emergencies if they work in a relevant clinical area [31,38,53,[135][136][137][138][139][140].…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

et al. 2012

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SummaryAdult tracheostomy and laryngectomy airway emergencies are uncommon, but do lead to significant morbidity and mortality. The National Tracheostomy Safety Project incorporates key stakeholder groups with multi‐disciplinary expertise in airway management. , the Intensive Care Society, the Royal College of Anaesthetists, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care and the National Patient Safety Agency. Resources and emergency algorithms were developed by consensus, taking into account existing guidelines, evidence and experiences. The stakeholder groups reviewed draft emergency algorithms and feedback was also received from open peer review. The final algorithms describe a universal approach to managing such emergencies and are designed to be followed by first responders. The project aims to improve the management of tracheostomy and laryngectomy critical incidents.

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“…Although these outcomes are commendable, we suggest that this intubation bundle or checklist could be improved by the inclusion of preparatory elements in the pre-intubation phase of the bundle. Difficult airway evaluation and the organisation of equipment, such as working suction, appropriate laryngoscopes, oropharyngeal airways and endotracheal tubes, is a prerequisite in all patients [2]. Most of this essential equipment can be pre-assembled in intubation packs, which could include a checklist in order to save time.…”

mentioning

confidence: 99%

Reducing complications related to endotracheal intubation in critically ill patients

2010

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Airway Management in Critical Illness

Cited by 116 publications

References 100 publications

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

Reducing complications related to endotracheal intubation in critically ill patients

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