Complications of endotracheal intubation in the critically ill

• Published in: Intensive care medicine 2008-10, Vol.34 (10), p.1835-1842
• Main Authors: Griesdale, Donald E. G., Bosma, T. Laine, Kurth, Tobias, Isac, George, Chittock, Dean R.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - statistics & numerical data; Adult; Aged; Airway management; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; British Columbia - epidemiology; Cardiac arrest; Clinical Competence; Critical care; Critical Care Medicine; Critical Illness; Data collection; Emergency and intensive respiratory care; Emergency medical care; Emergency Medicine; Esophagus; Female; Health care; Hospital Mortality; Hospitalists; Hospitals; Humans; Hypotension; Intensive; Intensive care; Intensive care medicine; Intensive Care Units - statistics & numerical data; Internship and Residency; Intubation; Intubation, Intratracheal - adverse effects; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Odds Ratio; Original; Pain Medicine; Patients; Pediatrics; Physicians; Pneumology/Respiratory System; Preventive medicine; Prospective Studies; Supervisors; Vital signs
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-008-1205-6

Objective Assess the risk of complications during endotracheal intubation (ETI) and their association with the skill level of the intubating physician. Design Prospective cohort study of 136 patients intubated by the intensive care team during a 5-month period. Standardized data forms were used to collect detailed information on the intubating physicians, supervisors, techniques, medications and complications. Setting Canadian academic intensive care unit. Measurements and results All intubations were successful and there were no deaths during intubation. Non-experts were supervised in 92% of procedures. Expert operators were successful within two attempts in 94%, compared to only 82% of non-experts ( P  = 0.03), with 13.2% of all intubations requiring ≥3 attempts. Furthermore, 10.3% of intubations required 10 or more minutes. Difficult intubation (3 or more attempts by an expert) occurred in 6.6%. Overall risk of complications was 39%, including: severe hypoxemia (19.1%), severe hypotension (9.6%), esophageal intubation (7.4%) and frank aspiration (5.9%). ICU and hospital mortality were 15.4 and 29.4%, respectively. Compared with non-expert intubating physicians, propensity score-adjusted odds ratios (95% confidence interval) for expert physicians were 0.92 (95% CI: 0.28, 3.05, P  = 0.89) for any complication, 0.45 (95% CI: 0.09, 2.20, P  = 0.32) for ICU mortality and 0.47 (95% CI: 0.13, 1.70, P  = 0.25) for hospital mortality. Two or more attempts at ETI was independently associated with an increased risk of severe complications (OR 3.31, 95% CI: 1.30, 8.40, P  = 0.01). Conclusions These prospective data show a high risk of serious complications, and difficult intubations, that are associated with ETI of the critically ill. Descriptor Artificial airways and complications.