PURPOSE: Rapid sequence intubation (RSI) is the standard of care for emergency airway management for intubations that are not anticipated to be difficult. RSI reduces gastric insufflation and resultant aspiration and decreases airway trauma. We conducted a retrospective study to determine the impact of RSI on extubation rates for critically ill patients.
METHODS: All patients admitted from the Emergency Department (ED) to the Medical Intensive Care Unite (MICU) from January 1, 2009 through August 31, 2009 that required intubation and mechanical ventilatory support were studied. RSI patients received a neuromuscular blocking agent either succinylcholine, vecuronium or rocuronium and a sedative usually propofol, etomidate or midazolam to render the patient rapidly flaccid and unconscious. Patients who did not undergo RSI were sedated prior to the intubation with propofol, etomidate or midazolam. Data was collected regarding the method of intubation, extubation rates and mortality.
RESULTS: 223 patients consecutively admitted to the MICU after intubation in the ER were studied. 107 patients were intubated with RSI and 116 with sedation only. 65 RSI patient (60.7%) were extubated as compared to 48 (41%) of non RSI patients (P=0.0048). The average age, APACHE II scores, SOFA scores and pressor requirements were similar for the two groups. No differences in MICU or hospital mortality were seen.
CONCLUSION: Rapid sequence intubation improves extubation rates in critically ill patients requiring mechanical ventilation.
CLINICAL IMPLICATIONS: RSI should be performed for critically ill patients needing intubation.
DISCLOSURE: Kavan Ramachandran, No Financial Disclosure Information; No Product/Research Disclosure Information