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 firstname.lastname@example.org.
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