Original

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

  • Samir JaberAffiliated withIntensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital, Université Montpellier 1 Email author 
  • , Boris JungAffiliated withIntensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital, Université Montpellier 1Service de Réanimation Médicale Assistance Respiratoire, CHU de Montpellier, Hôpital Gui-de-Chauliac
  • , Philippe CorneAffiliated withService de Réanimation Médicale Assistance Respiratoire, CHU de Montpellier, Hôpital Gui-de-Chauliac
  • , Mustapha SebbaneAffiliated withIntensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital, Université Montpellier 1
  • , Laurent MullerAffiliated withFédération Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire Nîmes
  • , Gerald ChanquesAffiliated withIntensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital, Université Montpellier 1
  • , Daniel VerzilliAffiliated withIntensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital, Université Montpellier 1
  • , Olivier JonquetAffiliated withService de Réanimation Médicale Assistance Respiratoire, CHU de Montpellier, Hôpital Gui-de-Chauliac
  • , Jean-Jacques EledjamAffiliated withIntensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching Hospital, Université Montpellier 1
    • , Jean-Yves LefrantAffiliated withFédération Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire Nîmes

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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