Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional Community Anesthetic Practice
| Autor: | Mary Cooter, Rebecca A. Schroeder, William Buhrman, Richard J. Pollard, Joseph P. Mathew, Ishwori Dhakal, Katherine P. Grichnik, Solomon Aronson, Mark Stafford-Smith, Miklos D. Kertai |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Resuscitation business.industry medicine.medical_treatment Tracheal intubation MEDLINE Retrospective cohort study Perioperative 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine 030202 anesthesiology Anesthetic medicine Intubation Airway management business Intensive care medicine 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Anesthesiology. 128:502-510 |
| ISSN: | 0003-3022 |
| DOI: | 10.1097/aln.0000000000001974 |
| Popis: | Background When tracheal intubation is difficult or unachievable before surgery or during an emergent resuscitation, this is a critical safety event. Consensus algorithms and airway devices have been introduced in hopes of reducing such occurrences. However, evidence of improved safety in clinical practice related to their introduction is lacking. Therefore, we selected a large perioperative database spanning 2002 to 2015 to look for changes in annual rates of difficult and failed tracheal intubation. Methods Difficult (more than three attempts) and failed (unsuccessful, requiring awakening or surgical tracheostomy) intubation rates in patients 18 yr and older were compared between the early and late periods (pre- vs. post-January 2009) and by annual rate join-point analysis. Primary findings from a large, urban hospital were compared with combined observations from 15 smaller facilities. Results Analysis of 421,581 procedures identified fourfold reductions in both event rates between the early and late periods (difficult: 6.6 of 1,000 vs. 1.6 of 1,000, P < 0.0001; failed: 0.2 of 1,000 vs. 0.06 of 1,000, P < 0.0001), with join-point analysis identifying two significant change points (2006, P = 0.02; 2010, P = 0.03) including a pre-2006 stable period, a steep drop between 2006 and 2010, and gradual decline after 2010. Data from 15 affiliated practices (442,428 procedures) demonstrated similar reductions. Conclusions In this retrospective assessment spanning 14 yr (2002 to 2015), difficult and failed intubation rates by skilled providers declined significantly at both an urban hospital and a network of smaller affiliated practices. Further investigations are required to validate these findings in other data sets and more clearly identify factors associated with their occurrence as clues to future airway management advancements. |
| Databáze: | OpenAIRE |
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