SESSION TITLE: Quality & Clinical Improvement I
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 04:30 PM - 05:30 PM
PURPOSE: Traditional risk factors (RF) of difficult urgent endotracheal intubation (UEI) described in anesthesia literature have been Mallampati score greater than three, decreased neck extension, decreased temporomandibular distance, limited mouth opening and obesity. With the advent of video laryngoscopy (VL) and a standardized team approach to UEI these traditional risk factors may have changed and may no longer predict difficult UEI. The purpose of this study was to review all consecutive UEIs performed in a large tertiary medical center MICU in order to evaluate and identify RF associated with difficult UEI in critically ill patients when VL is the predominant method of intubation.
METHODS: Prospective data was collected on all consecutive UEIs performed from August 2012 to August 2013. A standardized data collection sheet was used to record demographics, clinical characteristics (age, gender, BMI, history of intubation), baseline vital signs, SAPSII scores, airway evaluation and reason for intubation. Difficult intubation was defined as more than two attempts. The method of intubation, either VL or direct laryngoscopy (DL), and any complications during the UEI were also recorded.
RESULTS: Data from 139 UEIs were recorded, 122 with VL. There were 14/139 (10%) difficult intubations. Associations between difficult intubation and potential RF were examined using the Fisher’s exact test and Mann-Whitney test. There were no statistically significant differences between subjects who had a difficult and not difficult intubation with respect to gender, BMI, SAPSII scores, or airway evaluation (Mallampati score, mouth opening, neck extension and TM distance). The rates of pre-induction hypotension and hypoxemia were similar between groups. Only pre-intubation hypoxemia was associated with an increased risk of any complication during UEI.
CONCLUSIONS: VL and a standardized approach to UEI may change the traditional RFs for difficult intubation. In our cohort only pre-induction hypoxemia was associated with any complications. BMI does not seem to be a predictor of difficult intubation in critically ill patients when standardized approach and VL is used for intubations in the MICU.
CLINICAL IMPLICATIONS: Although there was a low incidence of difficult intubations in our study group, this further supports the safety and utility of VL in critically ill patients.
DISCLOSURE: The following authors have nothing to disclose: Annamaria Iakovou, Valerie Pershad, Seth Koenig, Viera Lakticova
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