Intensive Care Medicine

, Volume 36, Issue 2, pp 248–255

An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study

Authors

    • Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1
  • Boris Jung
    • Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1
    • Service de Réanimation Médicale Assistance Respiratoire, CHU de MontpellierHôpital Gui-de-Chauliac
  • Philippe Corne
    • Service de Réanimation Médicale Assistance Respiratoire, CHU de MontpellierHôpital Gui-de-Chauliac
  • Mustapha Sebbane
    • Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1
  • Laurent Muller
    • Fédération Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-Universitaire CaremeauCentre Hospitalier Universitaire Nîmes
  • Gerald Chanques
    • Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1
  • Daniel Verzilli
    • Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1
  • Olivier Jonquet
    • Service de Réanimation Médicale Assistance Respiratoire, CHU de MontpellierHôpital Gui-de-Chauliac
  • Jean-Jacques Eledjam
    • Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1
  • Jean-Yves Lefrant
    • Fédération Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-Universitaire CaremeauCentre Hospitalier Universitaire Nîmes
Original

DOI: 10.1007/s00134-009-1717-8

Cite this article as:
Jaber, S., Jung, B., Corne, P. et al. Intensive Care Med (2010) 36: 248. doi:10.1007/s00134-009-1717-8

Abstract

Objective

To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit (ICU).

Design

Two-phase, prospective, multicenter controlled study.

Setting

Three medical-surgical ICUs in two university hospitals.

Patients

Two hundred three consecutive ICU patients required 244 intubations.

Interventions

All intubations performed during two consecutive phases (a 6-month quality control phase followed by a 6-month intervention phase based on the implementation of an ICU intubation bundle management protocol) were evaluated. The ten bundle components were: preoxygenation with noninvasive positive pressure ventilation, presence of two operators, rapid sequence induction, cricoid pressure, capnography, protective ventilation, fluid loading, preparation and early administration of sedation and vasopressor use if needed.

Measurements and main results

The primary end points were the incidence of life-threatening complications occurring within 60 min after intubation (cardiac arrest or death, severe cardiovascular collapse and hypoxemia). Other complications (mild to moderate) were also evaluated. Baseline characteristics, including demographic data and reason for intubation (mainly acute respiratory failure), were similar in the two phases. The intubation procedure in the intervention phase (n = 121) was associated with significant decreases in both life-threatening complications (21 vs. 34%, p = 0.03) and other complications (9 vs. 21%, p = 0.01) compared to the control phase (n = 123).

Conclusions

The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients.

Keywords

Intubation Airway management Complications Mechanical ventilation Non-invasive ventilation Practice guidelines

Supplementary material

134_2009_1717_MOESM1_ESM.doc (186 kb)
Supplementary material 1 (DOC 186 kb)

Copyright information

© Copyright jointly hold by Springer and ESICM 2009