Approach to the Airway in the Emergency Department (ED) and Intensive Care Unit (ICU) in a Portuguese University Hospital Center: a prospective observational study

Abstract

Background Airway management is a commonly performed procedure in the Emergency Department (ED) and Intensive Care Unit (ICU), being tracheal intubation the gold standard with relatively high rates of complications in these settings. The purpose of our study was to analyse the airway approach in our institution at ED and ICU identifying the main complications associated and taking notice of possible factors related to them. Methods Prospective observational study conducted between May and September 2014 in the ICU and ED of Santo Antonio Hospital, with the primary aim of identifying the main complications of the airway approach in the critical patient and secondary aim to take notice of possible factors related with complications of the airway approach related to technical skills of the operator, patient´s specificities and airway approach techniques. The statistical analysis was done in cooperation with the Medical Informatics and Biostatistics Department of the Faculty of Medicine of the University of Porto. P values <0.05 were considered significant for all hypothesis testing. The analysis was done using the statistical analysis program SPSS® v.21.0 Results A total of 182 patients were included, corresponding to 257 attempted tracheal intubations (ATI). The rate of successful first-pass orotracheal intubation was 67%. Complications related to ATI were reported in 30% of all attempts, being most frequently among residents (81%, p=0.001) and those with little experience in airway approach (46%, p<0.001). The majority of complications was failed intubation (18%). In the group with complications, relation with an identifiable obvious cause was seen in 87% of cases (p<0.001), the major being inexperience in 42% of operators with complications, instead of 1% in the group without complications (p<0.001). Conclusions Failed ATI and its complications are largely dependent on operator´s expertise. Factors related to patient, lack of appropriate equipment and inappropriate strategy delineation also play a role. Recognition of patients at particular risk of difficult airway management is crucial.