An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study

Jaber, Samir; Jung, Boris; Corne, Philippe; Sebbane, Mustapha; Muller, Laurent; Chanques, Gérald; Verzilli, Daniel; Jonquet, O.; Eledjam, Jean‐Jacques; Lefrant, Jean‐Yves

doi:10.1007/s00134-009-1717-8

Cited by 417 publications

(373 citation statements)

References 35 publications

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“…5 Accordingly, the incidence of adverse events associated with EETI is high in comparison with elective endotracheal intubation performed in the operating theatre. [6][7][8][9][10] Adverse events during EETI range from relatively minor (local oropharyngeal soft tissue and dental trauma) to life threatening (dysrhythmias, hypoxia, hemodynamic instability, and cardiac arrest). [11][12][13] Hemodynamic instability in the postintubation phase is a potentially important adverse event associated with EETI that has not been fully described.…”

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

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“…Th e duration of the procedure usually corresponds with the time needed to prepare the drugs and equipment for intubation. NIV was included in a bundle and was associated with a decrease in life-threatening hypoxemia following intubation in a multicenter study [1], [2] ( Table 2).…”

Section: Non-invasive Ventilation With Positive Pressurementioning

confidence: 99%

“…To limit the incidence of severe complications occurring after this potentially hazardous procedure, we believe that the whole process (pre-, perand post-intubation) should be guided by protocols geared toward patient safety. We designed a multicenter study and described how implementation of such a bundle protocol could improve the safety of airway manage ment in the ICU [1], [2]. Th is bundle, the Montpellier-ICU intubation algorithm, is summarized in Table 2.…”

Section: Bundle To Limit Complications Related To Intubation (The Monmentioning

confidence: 99%

Intubation in the ICU: We Could Improve our Practice

Jong¹,

Jung²,

Jaber³

2014

Annual Update in Intensive Care and Emergency Medicine 2014

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Airway management is a commonly performed procedure in the intensive care unit (ICU). Hypoxemia and cardiovascular collapse represent the initial and most serious life-threatening complications associated with diffi cult airway access, both in emergency intubation in the critically ill [1]- [4] and in planned intubations (e. g., scheduled surgery or invasive procedures) [5]. To prevent and limit the incidence of life-threatening complications following intubation, several pre-oxygenation techniques and intubation algorithms have been entertained.Th e objectives of the present chapter are to: 1) describe new tools (e. g., the MACOCHA Score) to better identify patients at high-risk of diffi cult intubation and related complications; 2) describe new strategies for improving pre-oxygenation before intubation (e. g., continuous positive airway pressure [CPAP] or non-invasive ventilation [NIV]); 3) propose an intubation bundle (the Montpellier-ICU intubation algorithm) to limit complications related to the intubation procedure; 4) report recent data on the role of videolaryngoscopes in the ICU; and, fi nally, 5) propose an algorithm for secure airway management in the ICU (Th e Montpellier-airway ICU algorithm). Which patients are 'at risk' of complications during intubation?All ICU patients could be considered at risk of complications during intubation. How to identify risk factors for diffi cult intubation in the ICU?Although several predictive risk factors and scores for diffi cult intubation have been identifi ed in anesthesia practice, until recently no (a priori) clinical score had been developed for ICU patients. However, a recent study assessed risk factors for diffi cult intubation in the ICU [3] and developed a predictive score of diffi cult intubation, the MACOCHA score, which was then externally validated. Th e main predictors of diffi cult intubation were related to the patient (Mallampati score III or IV, obstructive sleep apnea syndrome, reduced mobility of cervical spine, limited mouth opening), the pathology (coma, severe hypoxia) and the operator (nonanesthesiologist) (Table 1). By optimizing the discrimination threshold, the discriminative ability of the score is high. In order to reject diffi cult intubation with certainty, a cut-off of 3 or greater seems appropriate, providing an optimal negative predictive value (97 % and 98 % in the original and validation cohorts, respectively) and sensitivity (76 % and 73 % in the original and validation cohorts, respectively). Th e MACOCHA score enables patients at risk of diffi cult intubation to be identifi ed and further studies are needed to determine whether calculating this score before each intubation could help

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“…7,23,26,27 Son incidence varie effectivement de 0% à 44% si l'on considère les études disponibles sur le sujet. 7,[21][22][23][24] Tant pour l'évaluation de son impact sur la mortalité que pour l'estimation de son incidence, la grande hétérogénéité des définitions d'HPI utilisées affectent la comparabilité des résultats et affaiblissent les conclusions cliniques potentielles.…”

Section: Introductionunclassified

L’incidence de l’hypotension post-intubation endotrachéale chez des patients en salle de réanimation: impact des définitions

Lévesque

Sage

Berthelot

et al. 2016

CJEM

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ObjectifNotre objectif primaire est de mesurer l’incidence d’HPI selon quatre définitions différentes retrouvées dans la littérature. Notre principal objectif secondaire est d’évaluer l’impact de la présence d’instabilité hémodynamique avant l’intubation sur l’incidence d’HPI. Le deuxième objectif secondaire consiste à déterminer l’incidence de l’HPI en fonction de l’intervalle de temps durant lequel la première hypotension survient.MéthodeUne cohorte prospective a été constituée par les patients intubés en salle de réanimation à l’hôpital de l’Enfant-Jésus entre le 28/06/2011 et le 12/07/2012. L’HPI était globalement définie comme ≥1 mesure de tension artérielle systolique <90 mmHg suivant l’intubation. Les différentes définitions étudiées faisaient varier le temps de mesure de la tension artérielle (TA) après l’intubation, soit 1) jusqu’à 5 minutes, 2) jusqu’à 15 minutes, 3) jusqu’à 30 minutes et 4) en tout temps lors du séjour en salle de réanimation.RésultatAu cours de la période à l’étude, 155 patients ont été intubés sur place dont 81 patients qui répondaient aux critères d’inclusion. L’incidence de l’HPI pour chaque définition est respectivement de 9.9%, 18.5%, 24.7% et 28.4%. La comparaison entre chacune de ces incidences révèle une différence statistiquement significative (p<0.05), à l’exception des deux dernières. L’incidence cumulative d’HPI à tout moment suivant l’intubation chez les patients présentant une hypotension pré-intubation est de 62.5% (IC 95% 28.5-87.5) en opposition aux patients hémodynamiquement stables en pré-intubation qui présentaient une incidence d’HPI de 24.7% (IC 95% 16.1-35.8).ConclusionL’hypotension post-intubation est un effet indésirable fréquent chez les patients au département d’urgence et son incidence varie de façon significative en fonction de la définition temporelle utilisée au sein d’une même cohorte de patients.

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An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study

Abstract: The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients.

Cited by 417 publications

References 35 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

Intubation in the ICU: We Could Improve our Practice

L’incidence de l’hypotension post-intubation endotrachéale chez des patients en salle de réanimation: impact des définitions

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