Tracheal intubation in the critically ill: a multi-centre national study of practice and complications

Simpson, G.D.; Ross, Mark; McKeown, Dermot; Ray, David C.

doi:10.1093/bja/aer504

Cited by 229 publications

(235 citation statements)

References 33 publications

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“…37 Moreover, other authors have found a very high success rate of airway management by skilled operators outside the OR without 38 or with very infrequent use of VLs. 28,38,39 Despite the rapidly growing use of VLs in the ED and ICU, there is still no evidencebased paradigm where primary airway management outside the OR, particularly endotracheal intubation, relies mainly on video-laryngoscopy.…”

Section: Etiologies Of Airway Complications Outside the Ormentioning

confidence: 99%

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Paolini

Donati

Drolet

2012

Can J Anesth/J Can Anesth

162

149

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Background An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Principal findings Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety.

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Section: Etiologies Of Airway Complications Outside the Ormentioning

confidence: 99%

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Paolini

Donati

Drolet

2012

Can J Anesth/J Can Anesth

162

149

View full text Add to dashboard Cite

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“…Fluid administration prior to the intubation might have reduced the rate of cardiac arrest by avoiding hypotension. In studies with etomidate which has less adverse effects on hemodynamics than other agents, a single dose of etomidate was shown not to have any effect on mortality in patients with septic shock (10,11). Ketamine is another preferred agent in patients with septic shock.…”

Section: Discussionmentioning

confidence: 99%

Complications of Endotracheal Intubation in the Intensive Care Unit: A Single-center Experience after Training

Bahar¹,

Elay²,

Coşkun³

et al. 2015

Erciyes Med J

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Objective: Endotracheal intubation is a frequently performed procedure in the intensive care unit (ICU). Extremely serious complications occur during this procedure. In this study, theoretical and practical training were given to residents who started to work in the medical intensive care unit, and it was aimed to evaluate the complications following training. Materials and Methods:This study was conducted prospectively.Results: A total of 36 patients were included in the study; 16 (45%) were male, and the average age of the patients was 64±16.0 years. The most common indications for admittance to the ICU were shock (50%) and acute respiratory failure (36%). The most common indication for intubation was determined as acute respiratory failure (44%). The intubation was performed as an emergency procedure in 27% of these patients, whereas it was performed semi-urgently in 8% and electively in 65%. Among intubated patients, at least one complication developed in 13 (36%) cases. The drugs most commonly used for sedation were midazolam (76%) and propofol (16.7%). Conclusion:Complications of endotracheal intubation are significant problems in ICUs. A successful procedure of intubation avoids complications. Regular training for endotracheal intubation in the ICU decreases the complications.

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“…[14][15][16][17]19] According to Simpson et al, [14] capnography should be used to confirm ETT position in all intubations, including those performed outside the operating theatre. [13] Delorio [15] confirmed that capnography is the recommended method for ETT verification, but also recognised that the use of capnography is limited and is often either not available or inconsistently applied in ETT verification.…”

Section: Capnographymentioning

confidence: 99%

Endotracheal tube verification in adult mechanically ventilated patients

2015

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Objective. To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients.Methods. An integrative literature search was conducted in 2012 -2013 of research citations published in English on the topic of discussion. Electronic databases searched were: the Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, PubMed, the Joanna Briggs Institute (JBI) systematic review library, the Cochrane Library and the National Guidelines Clearinghouse. In addition, reference lists of articles, conference summaries and hand searching was performed. Citations were selected based on the inclusion and exclusion criteria as decided upon by the researchers. The process of critical appraisal was done by the researchers as well as an independent reviewer, all skilled in the research methodology and subject matter related to the topic of discussion. A total of 45 articles were included for critical appraisal. On completion of the critical appraisal, which was done by two independent reviewers, 34 articles were excluded and 11 articles were included in the integrative review analyses. Data were extracted following the critical appraisal process. Owing to the heterogeneity of studies, a metasynthesis could not be done. Results. Based on the reviewed studies, various methods have been identified to verify ETT placement in adult mechanically ventilated patients, namely ultrasonography, the use of centimetre scale printed on the ETT, manual cuff palpation, bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography. Both ultrasonography and capnography had excellent sensitivity and specificity in verifying ETT placement. Conclusion. Although there are various methods reported for ETT verification, the review results recommended ultrasonography and capnography as the most accurate and reliable verification methods.

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Tracheal intubation in the critically ill: a multi-centre national study of practice and complications

Cited by 229 publications

References 33 publications

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Complications of Endotracheal Intubation in the Intensive Care Unit: A Single-center Experience after Training

Endotracheal tube verification in adult mechanically ventilated patients

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