Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications
AffiliationUniv Arizona, Sect Pulm Allergy Crit Care & Sleep, Dept Med
Univ Arizona, Dept Emergency Med
Univ Arizona, Coll Med
Intensive care units
MetadataShow full item record
PublisherSPRINGER-VERLAG ITALIA SRL
CitationHypes, C., Sakles, J., Joshi, R. et al. Intern Emerg Med (2017) 12: 1235. https://doi.org/10.1007/s11739-016-1549-9
JournalINTERNAL AND EMERGENCY MEDICINE
Rights© SIMI 2016
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractThe 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 %), whereas > 1 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 that > 1 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.
Note12 month embargo; published online: 13 October 2016
VersionFinal accepted manuscript
CollectionsUA Faculty Publications
- Video Laryngoscopy Improves Odds of First-Attempt Success at Intubation in the Intensive Care Unit. A Propensity-matched Analysis.
- Authors: Hypes CD, Stolz U, Sakles JC, Joshi RR, Natt B, Malo J, Bloom JW, Mosier JM
- Issue date: 2016 Mar
- Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit.
- Authors: Joshi R, Hypes CD, Greenberg J, Snyder L, Malo J, Bloom JW, Chopra H, Sakles JC, Mosier JM
- Issue date: 2017 Mar
- Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit.
- Authors: Mosier JM, Whitmore SP, Bloom JW, Snyder LS, Graham LA, Carr GE, Sakles JC
- Issue date: 2013 Oct 14
- Neuromuscular blockade improves first-attempt success for intubation in the intensive care unit. A propensity matched analysis.
- Authors: Mosier JM, Sakles JC, Stolz U, Hypes CD, Chopra H, Malo J, Bloom JW
- Issue date: 2015 May
- Improvement in glottic visualisation by using the C-MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study.
- Authors: Hossfeld B, Frey K, Doerges V, Lampl L, Helm M
- Issue date: 2015 Jun