Endotracheal Intubation Among the Critically Ill: Protocol for a Multicenter, Observational, Prospective Study

Abstract

BackgroundEndotracheal intubation can occur in up to 60% of critically ill patients. Despite the frequency with which endotracheal intubation occurs, the current practice is largely unknown. This is relevant, as advances in airway equipment (ie, video laryngoscopes) have become more prevalent, leading to possible improvement of care delivered during this process. In addition to new devices, a greater emphasis on airway plans and choices in sedation have evolved, although the influence on patient morbidity and mortality is largely unknown.ObjectiveThis study aims to derive and validate prediction models for immediate airway and hemodynamic complications of intensive care unit intubations.MethodsA multicenter, observational, prospective study of adult critically ill patients admitted to both medical and surgical intensive care units (ICUs) was conducted. Participating ICU sites were located throughout eight health and human services regions of the United States for which endotracheal intubation was needed. A steering committee composed of both anesthesia and pulmonary critical care physicians proposed a core set of data variables. These variables were incorporated into a data collection form to be used within the multiple, participating ICUs across the United States during the time of intubation. The data collection form consisted of two basic components, focusing on airway management and hemodynamic management. The form was generated using RedCap and distributed to the participating centers. Quality checks on the dataset were performed several times with each center, such that they arrived at less than 10% missing values for each data variable; the checks were subsequently entered into a database.ResultsThe study is currently undergoing data analysis. Results are expected in November 2018 with publication to follow thereafter. The study protocol has not yet undergone peer review by a funding body.ConclusionsThe overall goal of this multicenter prospective study is to develop a scoring system for peri-intubation, hemodynamic, and airway-related complications so we can stratify those patients at greatest risk for decompensation as a result of these complications. This will allow critical care physicians to be better prepared in addressing these occurrences and will allow them to improve the quality of care delivered to the critically ill.Trial RegistrationClinicalTrials.gov NCT02508948; https://clinicaltrials.gov/ct2/show/NCT02508948 (Archived by WebCite at http://www.webcitation.org/73Oj6cTFu)International Registered Report Identifier (IRRID)RR1-10.2196/11101

Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study

“…A pre-specified standardized case report form, developed by anesthesia, medicine, and pulmonary critical care physicians, focused on two periprocedural aspects of the ETI process—hemodynamic and airway management [ 18 ]. The various sites entered data into the Research Electronic Data Capture platform, which was managed and analyzed at Mayo Clinic Rochester.…”

“…To assist with data collection and standardization, a registry (https://www.haemair.com/) and monthly HEMAIR investigator meetings were established. Regarding airway management, rapid sequence intubation was defined a priori [18]. This was a pragmatic study and as such the ETI process was not standardized.…”

Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

“…However, a standardized case report form with guidance from anesthesia, medicine, and pulmonary critical care physicians was developed focusing on both hemodynamic and airway management of endotracheal intubations. 14 In addition, monthly investigator meetings were established to assist with data collection and standardization. A standardized operating manual and HEMAIR registry (www.hemair.org) were also created aprior to further assist with data collection.…”

“…The primary outcome was defined as: any pulse oximetry reading ≤ 88% from the time of intubation to 30 minutes following endotracheal intubation. 14 Data on the primary outcome were collected by trained study personnel in real time at the bedside using lowest oxygenation saturation value. The cutoff value of 88% was selected based on literature showing that targeting a conservative oxygenation strategy (88-92%) resulted in no significant difference in vasopressor free days, ventilator free days, and ICU or 28 day mortality as compared to targeting a more liberal oxygenation strategy (≥96%).…”

Factors Contributing to Post Extubation Dysphagia in Critically Ill Patients

“…Around 60% of critical ill patients admitted to ICU requiring endotracheal intubation as mean to maintain open-air way and deliver invasive mechanical ventilation. Endotracheal intubation as a process is used to maintain a patent, protected airway; and to support ventilation for patients who are unable to breathe adequately on their own (3,4) . Endotracheal tube intubation had direct contact with structure of airway which lead to mucosal lesions this may be related to traumatic causes during insertion, prolonged time of intubation, use of large size of tube and increase cuff pressure more than normal range (5)(6)(7) .…”