Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications
| Autor: | John W. Bloom, Jarrod Mosier, John C. Sakles, Cameron Hypes, Raj Joshi, Harsharon Chopra, Bhupinder Natt, Jeremy Greenberg, Josh Malo |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Laryngoscopy Pneumonia Aspiration Hypoxemia law.invention 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law Intubation Intratracheal Internal Medicine medicine Humans Intubation Airway Management Intensive care medicine Aged medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Middle Aged Intensive care unit Intensive Care Units Logistic Models Emergency medicine Emergency Medicine Female Airway management Observational study medicine.symptom Complication business Airway |
| Zdroj: | Internal and Emergency Medicine. 12:1235-1243 |
| ISSN: | 1970-9366 1828-0447 |
| Popis: | The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p 0.001) of those requiring more than one attempt. Logistic regression analysis shows that1 attempt is associated with 6.4 (95 % CI 4.4-9.3) times the adjusted odds of at least one complication. Pre-intubation predictors of at least one complication despite first attempt success include vomit or edema in the airway as well as the presence of hypoxemia or hypotension. There are increased odds of complications with even a second attempt at intubation in the Intensive Care Unit. Complications occur frequently despite a successful first attempt, and as such, the goal of airway management should not be simply first attempt success, but instead first attempt success without complications. |
| Databáze: | OpenAIRE |
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