First Pass Success Without Hypoxemia Is Increased With the Use of Apneic Oxygenation During Rapid Sequence Intubation in the Emergency Department

Sakles, John C.; Mosier, Jarrod; Patanwala, Asad E.; Arcaris, Brittany; Dicken, J.

doi:10.1111/acem.12931

Cited by 60 publications

(74 citation statements)

References 38 publications

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“…Furthermore, as adjunctive strategies such as ramp positioning (12)(13)(14) and apneic oxygenation (15,16) have become increasingly recognized as potentially beneficial, a continuous training curriculum provides opportunities for evaluating trainees' knowledge of these techniques and reinforcing their incorporation into airway management.…”

Section: Discussionmentioning

confidence: 99%

Airway registry and training curriculum improve intubation outcomes in the intensive care unit

Malo¹,

Hypes²,

Cristan³

et al. 2018

Southwest J Pulm Crit Care

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Background: Intubation in critically ill patients remains a highly morbid procedure, and the optimal approach is unclear. We sought to improve the safety of intubation by implementing a simulation curriculum and monitoring performance with an airway registry. Methods and Methods: This is a prospective, single-center observational study of all intubations performed by the medical intensive care unit (ICU) team over a five-year period. All fellows take part in a simulation curriculum to improve airway management performance and minimize complications. An airway registry form is completed immediately after each intubation to capture relevant patient, operator, and procedural data. Results: Over a five-year period, the medical ICU team performed 1411 intubations. From Year 1 to Year 5, there were significant increases in first-attempt success (72.6 vs. 88.0%, p<0.001), use of video laryngoscopy (72.3 vs. 93.5%, p<0.001), and use of neuromuscular blocking agents (73.5 vs. 88.4%, p<0.001). There were concurrent decreases in rates of desaturation (25.6 vs. 17.1%, p=0.01) and esophageal intubations (5 vs. 1%, p=0.009). Low rates of hypotension (8.3%) and cardiac arrest (0.6%) were also observed. Conclusions: The safety of intubation in critically ill patients can be markedly improved through joint implementation of an airway registry and simulation curriculum.

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Section: Discussionmentioning

confidence: 99%

Airway registry and training curriculum improve intubation outcomes in the intensive care unit

Malo¹,

Hypes²,

Cristan³

et al. 2018

Southwest J Pulm Crit Care

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show abstract

“…[262728] The use of an apneic oxygenation by simple nasal cannula at 15 L/min to prolong the duration of safe apnea after the administration of neuromuscular blockade has been advocated in the ED. [28] However, a recent randomized trial did not show benefit of apneic oxygenation during TI in critically ill patients,[29] possibly because the effectiveness of apneic oxygenation in the critically ill patient may be limited by the presence of illness-causing a physiologic shunt.…”

Section: Special Considerations During Tracheal Intubation In Intensimentioning

confidence: 99%

Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

Myatra

Kundra

Garg

et al. 2017

Indian Journal of Critical Care Medicine

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Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60–70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

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“…[262728] The use of an apnoeic oxygenation by simple nasal cannula at 15 L/min to prolong the duration of safe apnoea after the administration of neuromuscular blockade has been advocated in the ED. [28] However, a recent randomised trial did not show the benefit of apnoeic oxygenation during TI in critically ill patients,[29] possibly because the effectiveness of apnoeic oxygenation in the critically ill patient may be limited by the presence of illness causing a physiologic shunt.…”

Section: Special Considerations During Tracheal Intubation In the Intmentioning

confidence: 99%

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

et al. 2016

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Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60–70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

show abstract

First Pass Success Without Hypoxemia Is Increased With the Use of Apneic Oxygenation During Rapid Sequence Intubation in the Emergency Department

Cited by 60 publications

References 38 publications

Airway registry and training curriculum improve intubation outcomes in the intensive care unit

Airway registry and training curriculum improve intubation outcomes in the intensive care unit

Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

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