Complications des intubations trachéales difficiles dans un service de réanimation médicale

Tacon, S. Le; Wolter, Pascal; Rusterholtz, Thierry; Harlay, Marie-Line; Gayol, Saul; Sauder, P; Jaeger, Annick De

doi:10.1016/s0750-7658(00)00316-6

Cited by 50 publications

(16 citation statements)

References 15 publications

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“…The reason given for not using hypnotics was haemodynamic instability. Le Tacon et al did not routinely use muscle relaxants and had results similar to ours 3 . Their total incidence of difficult intubation was 22.5%, but analysis of patient subgroups showed a much lower incidence with rapid sequence induction with relaxation.…”

Section: Discussionsupporting

confidence: 80%

“…The airway management equipment used on patients in the study were Macintosh laryngoscope blades, sizes 3 The algorithm for tracheal intubation in the ICU that was valid during the study period proscribed an initial attempt with direct laryngoscopy, except in patients with severe haemodynamic instability or expected difficult intubation, in whom a fibrescope or blind nasal technique was to be employed. The algorithm required the initial attempts at intubation to be performed without the use of muscle relaxants.…”

Section: Methodsmentioning

confidence: 99%

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Incidence of Difficult Intubation in Intensive Care Patients: Analysis of Contributing Factors

Heuer

Barwing

et al. 2012

Anaesth Intensive Care

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Difficulties in endotracheal intubation increase morbidity and mortality in intensive care patients. We studied the problem in surgical intensive care patients with the aim of risk reduction. Patients intubated in the intensive care unit were evaluated. The intubations were performed or supervised by anaesthetists following the algorithm valid at the time of the study. Fifty percent of the 198 intubations were performed by specialist anaesthetists, 41.5% by anaesthesia trainees and 8.5% by surgical trainees. The initial attempt was by direct laryngoscopy (n=173), flexible fibrescope (n=8) or blind nasal technique (n=17). When direct laryngoscopy failed (n=7), intubation was accomplished with an intubating laryngeal mask airway (n=5), Frova stylet (n=1) or fibrescope (n=1). Thirty percent were rated as easy, 47% as moderately easy and 23% as difficult. Difficult intubations were associated with a higher incidence of anatomic anomalies, difficult bag-mask ventilation and severe oxygen desaturation. Every intubation in the ICU setting should be considered potentially difficult. The existing algorithm should be modified to incorporate the American Society of Anesthesiologists difficult airway algorithm adapted to the needs of the intensive care unit. A training program for alternative methods of airway management for difficult intubations should be established.

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Section: Discussionsupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Incidence of Difficult Intubation in Intensive Care Patients: Analysis of Contributing Factors

Heuer

Barwing

et al. 2012

Anaesth Intensive Care

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“…Recent studies have stated that the occurrence of difficult intubations in critically ill patients ranges from 10 to 22% [1-3]. In our study, the rate of difficult laryngoscopy (C&L grade 3 and 4) using ML was 20%.…”

Section: Discussionmentioning

confidence: 46%

“…This is remarkable since the large majority of physicians participating in this study were anesthesiologists. A French study reported a similar incidence of difficult laryngoscopy [3]. The incidence of difficult laryngoscopies reported for the operating room (5%) is significantly less frequent than in other settings [17].…”

Section: Discussionmentioning

confidence: 97%

“…For example, the incidence of difficult endotracheal intubations is higher in the ICU than in the operating room. The number of difficult intubations ranges from 10 to 22% in critically ill patients [1-3]. Visualizing the glottis is often difficult in the ICU due to the constraints of space, the position of the patient and the accompanying comorbidities [4].…”

Section: Introductionmentioning

confidence: 99%

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Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU

et al. 2012

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IntroductionEndotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy.MethodsIn a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®).ResultsA total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001).ConclusionUse of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur.

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Endotracheal Intubation in the ICU

Jaber¹,

Jung²,

Chanques³

2009

Intensive Care Medicine

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Complications des intubations trachéales difficiles dans un service de réanimation médicale

Cited by 50 publications

References 15 publications

Incidence of Difficult Intubation in Intensive Care Patients: Analysis of Contributing Factors

Incidence of Difficult Intubation in Intensive Care Patients: Analysis of Contributing Factors

Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU

Endotracheal Intubation in the ICU

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