1. Incidence of Difficult Intubation in Intensive Care Patients: Analysis of Contributing Factors
- Author
-
Onnen Mörer, Thomas A Barwing, Elisa Bleckmann, Jan Florian Heuer, Sebastian G. Russo, Onnen Moerer, Juergen Barwing, and Michael Quintel
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Laryngoscopy ,Critical Care and Intensive Care Medicine ,Laryngeal Masks ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030202 anesthesiology ,law ,Intensive care ,Intubation, Intratracheal ,Fiber Optic Technology ,Humans ,Medicine ,Intubation ,Aged ,Difficult intubation ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,030208 emergency & critical care medicine ,Middle Aged ,Intensive care unit ,3. Good health ,Stylet ,Intensive Care Units ,Anesthesiology and Pain Medicine ,Emergency medicine ,Female ,Airway management ,business ,Algorithms - Abstract
Difficulties in endotracheal intubation increase morbidity and mortality in intensive care patients. We studied the problem in surgical intensive care patients with the aim of risk reduction. Patients intubated in the intensive care unit were evaluated. The intubations were performed or supervised by anaesthetists following the algorithm valid at the time of the study. Fifty percent of the 198 intubations were performed by specialist anaesthetists, 41.5% by anaesthesia trainees and 8.5% by surgical trainees. The initial attempt was by direct laryngoscopy (n=173), flexible fibrescope (n=8) or blind nasal technique (n=17). When direct laryngoscopy failed (n=7), intubation was accomplished with an intubating laryngeal mask airway (n=5), Frova stylet (n=1) or fibrescope (n=1). Thirty percent were rated as easy, 47% as moderately easy and 23% as difficult. Difficult intubations were associated with a higher incidence of anatomic anomalies, difficult bag-mask ventilation and severe oxygen desaturation. Every intubation in the ICU setting should be considered potentially difficult. The existing algorithm should be modified to incorporate the American Society of Anesthesiologists difficult airway algorithm adapted to the needs of the intensive care unit. A training program for alternative methods of airway management for difficult intubations should be established.
- Published
- 2012