High-Risk Airway Management in the Emergency Department. Part I: Diseases and Approaches

Lentz, Skyler; Grossman, Alexandra; Koyfman, Alex; Long, Brit

doi:10.1016/j.jemermed.2020.05.008

Cited by 25 publications

(18 citation statements)

References 74 publications

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“…In contrast, most studies characterize the pathophysiology of PH in intubation and mechanical ventilation and propose strategies to prevent RV failure. 1 , 17 Our analysis contributes to current knowledge with the identification of the post-intubation period as a vulnerable time for PH patients, and we propose that these early post-intubation complications may contribute to their overall adverse outcomes.…”

Section: Discussionmentioning

confidence: 67%

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Hong

Toppen

Lee

et al. 2022

J Intensive Care Med

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Background: Emergent endotracheal intubations (ETI) in pulmonary hypertension (PH) patients are associated with increased mortality. Post-intubation interventions that could increase survivability in this population have not been explored. We evaluate early clinical characteristics and complications following emergent endotracheal intubation and seek predictors of adverse outcomes during this post-intubation period. Methods: Retrospective cohort analysis of adult patients with groups 1 and 3 PH who underwent emergent intubation between 2005-2021 in medical and liver transplant ICUs at a tertiary medical center. PH patients were compared to non-PH patients, matched by Charlson Comorbidity Index. Primary outcomes were 24-h post-intubation and inpatient mortalities. Various 24-h post-intubation secondary outcomes were compared between PH and control cohorts. Results: We identified 48 PH and 110 non-PH patients. Pulmonary hypertension was not associated with increased 24-h mortality (OR 1.32, 95%CI 0.35-4.94, P = .18), but was associated with inpatient mortality (OR 4.03, 95%CI 1.29-12.5, P = .016) after intubation. Within 24 h post-intubation, PH patients experienced more frequent acute kidney injury (43.5% vs. 19.8%, P = .006) and required higher norepinephrine dosing equivalents (6.90 [0.13-10.6] mcg/kg/min, vs. 0.20 [0.10-2.03] mcg/kg/min, P = .037). Additionally, the median P/F ratio (PaO2/FiO2) was lower in PH patients (96.3 [58.9-201] vs. 233 [146-346] in non-PH, P = .001). Finally, a post-intubation increase in PaCO2 was associated with mortality in the PH cohort (post-intubation change in PaCO2 +5.14 ± 16.1 in non-survivors vs. −18.7 ± 28.0 in survivors, P = .007). Conclusions: Pulmonary hypertension was associated with worse outcomes after emergent endotracheal intubation than similar patients without PH. More importantly, our data suggest that the first 24 hours following intubation in the PH group represent a particularly vulnerable period that may determine long-term outcomes. Early post-intubation interventions may be key to improving survival in this population.

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Section: Discussionmentioning

confidence: 67%

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Hong

Toppen

Lee

et al. 2022

J Intensive Care Med

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“…Durante la historia médica, la competencia del manejo de la VA compleja ha estado en manos de la anestesiología y en menor medida de la medicina intensiva, sin embargo, dada la necesidad presente, esta competencia ha sido desarrollada en la medicina de urgencia (Lentz et al, 2020). El manejo avanzado de VA es una competencia que debe estar disponible en una unidad de urgencia.…”

Section: Discussionunclassified

Intubación endotraqueal de emergencia en paciente con estridor inspiratorio y hallazgo de tumor en cuerdas vocales: reporte de un caso

Vidal¹,

Aravena²

2022

ARS med

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El manejo especializado de la vía aérea (VA) es fundamental en las unidades de urgencia donde la intubación orotraqueal ha sido la técnica de elección para lograrlo. Una VA difícil se define como una situación clínica en la cual un equipo médico entrenado experimenta dificultades en la ventilación y/o en intubación. La obstrucción aguda de la VA constituye una de las emergencias médicas más extremas, requiriendo intervención inmediata. Se presenta el caso de un paciente con estridor inspiratorio con criterios inmediatos de intubación donde se evidencia un tumor en cuerdas vocales con obstrucción de la vía aérea.

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“…In emergency departments (ED) worldwide, clinicians are trained to intubate patients who decompensate in respiratory status and those who present in respiratory distress refractory to other measures. 1 , 2 A variety of methods for intubation, medications for paralysis and sedation, and associated adverse events with ED intubation have been characterized in the literature. 3 With such a variety of options available to ED physicians, patient factors such as medical history and presenting symptoms can help guide the techniques utilized.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of difficult airway identifiers for intubation‐related complications in the emergency department

Calamari

Politano

Brannan

et al. 2021

Laryngoscope Investig Oto

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Objectives: The Airway Alert banner at our institution alerts physicians to patients with the potential for a difficult intubation. Difficult airway guidelines can reduce intubation complications in the operating room, but little research has been done in the emergency department (ED). We hypothesize that patients meeting criteria for the banner will have a more difficult intubation and increased complications.Methods: Patients greater than 18 years old who presented to the ED for any complaint and required intubation were reviewed from January 2015 to January 2020 and divided into those meeting criteria for a difficult airway ("criteria cohort") and those who did not ("non-criteria cohort"). Past medical history and details of the intubation were collected. Results:The mean number of attempts for intubation was 1.60 in the criteria cohort and 1.36 in the non-criteria cohort (P > .05). The mean grade of view was 1.73 and 1.39, respectively (P < .05). The average size of endotracheal tube was 7.50 and 7.74 in the criteria and non-criteria cohorts (P < .05). The use of adjuncts was 28.6% and 12.5%, respectively (P < .01). The average number of intubation attempts and complication rate did not differ significantly.Conclusions: Intubations in patients meeting criteria for the banner are associated with a more difficult view, use of smaller endotracheal tube, and increased use of adjuncts, but not with a significantly higher rate of complications or attempts. Physicians should prepare with additional endotracheal tube sizes, adjuncts, and a plan for secondary strategies in these patients.

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High-Risk Airway Management in the Emergency Department. Part I: Diseases and Approaches

Cited by 25 publications

References 74 publications

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Intubación endotraqueal de emergencia en paciente con estridor inspiratorio y hallazgo de tumor en cuerdas vocales: reporte de un caso

Predictive value of difficult airway identifiers for intubation‐related complications in the emergency department

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