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Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications

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Abstract

The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas >1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p < 0.001) of those requiring more than one attempt. Logistic regression analysis shows that >1 attempt is associated with 6.4 (95 % CI 4.4–9.3) times the adjusted odds of at least one complication. Pre-intubation predictors of at least one complication despite first attempt success include vomit or edema in the airway as well as the presence of hypoxemia or hypotension. There are increased odds of complications with even a second attempt at intubation in the Intensive Care Unit. Complications occur frequently despite a successful first attempt, and as such, the goal of airway management should not be simply first attempt success, but instead first attempt success without complications.

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References

  1. Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, Hung OR, Jones PM, Kovacs G, Massey S, Morris IR, Mullen T, Murphy MF, Preston R, Naik VN, Scott J, Stacey S, Turkstra TP, Wong DT (2013) The difficult airway with recommendations for management–part 1–difficult tracheal intubation encountered in an unconscious/induced patient. Canadian journal of anaesthesia. J Can Anesth 60(11):1089–1118. doi:10.1007/s12630-013-0019-3

    Article  Google Scholar 

  2. Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O’Sullivan EP, Woodall NM, Ahmad I (2015) Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 115(6):827–848. doi:10.1093/bja/aev371

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A, American Society of Anesthesiologists Task Force on Management of the Difficult A (2013) Practice guidelines for management of the difficult airway: an updated report by the American society of anesthesiologists task force on management of the difficult airway. Anesthesiology 118(2):251–270. doi:10.1097/ALN.0b013e31827773b2

    Article  PubMed  Google Scholar 

  4. Le Tacon S, Wolter P, Rusterholtz T, Harlay M, Gayol S, Sauder P, Jaeger A (2000) Complications of difficult tracheal intubations in a critical care unit. Ann Fr Anesth Reanim 19(10):719–724

    Article  PubMed  Google Scholar 

  5. Jaber S, Amraoui J, Lefrant J, Arich C, Cohendy R, Landreau L, Calvet Y, Capdevila X, Mahamat A, Eledjam J (2006) Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 34:2355–2361

    Article  PubMed  Google Scholar 

  6. Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR (2008) Complications of endotracheal intubation in the critically ill. Intensive Care Med 34(10):1835–1842. doi:10.1007/s00134-008-1205-6

    Article  PubMed  Google Scholar 

  7. De Jong A, Clavieras N, Conseil M, Coisel Y, Moury PH, Pouzeratte Y, Cisse M, Belafia F, Jung B, Chanques G, Molinari N, Jaber S (2013) Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study. Intensive Care Med 39(12):2144–2152. doi:10.1007/s00134-013-3099-1

    Article  PubMed  Google Scholar 

  8. Bair A, Caravelli R, Tyler K, Laurin E (2010) Feasibility of the preoperative Mallampati airway assessment in emergency department patients. J Emerg Med 38:677–680

    Article  PubMed  Google Scholar 

  9. Levitan R, Everett W, Ochroch E (2004) Limitations of difficult airway prediction in patients intubated in the emergency department. Ann Emerg Med 44:307–313

    Article  PubMed  Google Scholar 

  10. Norskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrom LH (2015) Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia 70(3):272–281. doi:10.1111/anae.12955

    Article  CAS  PubMed  Google Scholar 

  11. Mort T (2004) Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 99:607–613

    Article  PubMed  Google Scholar 

  12. Sakles J, Chiu S, Mosier J, Walker C, Stolz U (2013) The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med 20:71–78

    Article  Google Scholar 

  13. Heffner AC, Swords D, Kline JA, Jones AE (2012) The frequency and significance of postintubation hypotension during emergency airway management. J Crit Care 27:417.e9–417.e13. doi:10.1016/j.jcrc.2011.08.011

    Article  Google Scholar 

  14. Heffner AC, Swords DS, Nussbaum ML, Kline JA, Jones AE (2012) Predictors of the complication of postintubation hypotension during emergency airway management. J Crit Care 27(6):587–593. doi:10.1016/j.jcrc.2012.04.022

    Article  PubMed  Google Scholar 

  15. Smischney NJ, Demirci O, Diedrich DA, Barbara DW, Sandefur BJ, Trivedi S, McGarry S, Kashyap R (2016) Incidence of and risk factors for post-intubation hypotension in the critically Ill. Med Sci Monit Int Med J Exp Clin Res 22:346–355

    Google Scholar 

  16. Green RS, Turgeon AF, McIntyre LA, Fox-Robichaud AE, Fergusson DA, Doucette S, Butler MB, Erdogan M, Canadian Critical Care Trials G (2015) Postintubation hypotension in intensive care unit patients: a multicenter cohort study. J Crit Care 30(5):1055–1060. doi:10.1016/j.jcrc.2015.06.007

    Article  PubMed  Google Scholar 

  17. Mosier JM, Malo J, Sakles JC, Hypes CD, Natt B, Snyder L, Knepler J, Bloom JW, Joshi R, Knox K (2015) The impact of a comprehensive airway management training program for pulmonary and critical care medicine fellows. A three-year experience. Annals Am Thorac Soc 12(4):539–548. doi:10.1513/AnnalsATS.201501-023OC

    Article  Google Scholar 

  18. Schwartz D, Matthay M, Cohen N (1995) Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 82:367–376

    Article  CAS  PubMed  Google Scholar 

  19. De Jong A, Molinari N, Terzi N, Mongardon N, Arnal JM, Guitton C, Allaouchiche B, Paugam-Burtz C, Constantin JM, Lefrant JY, Leone M, Papazian L, Asehnoune K, Maziers N, Azoulay E, Pradel G, Jung B, Jaber S, AzuRea Network for the Frida-Rea Study G (2013) Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med 187(8):832–839. doi:10.1164/rccm.201210-1851OC

    Article  PubMed  Google Scholar 

  20. Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, Constantin JM (2015) Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care 19:257. doi:10.1186/s13054-015-0975-9

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC (2015) The physiologically difficult airway. West J Emerg Med 16(7):1109–1117. doi:10.5811/westjem.2015.8.27467

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA

    Cameron Hypes, Raj Joshi, Jeremy Greenberg, Bhupinder Natt, Josh Malo, John Bloom & Jarrod Mosier

  2. Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, FOB 122C, Tucson, AZ, 85724, USA

    Cameron Hypes, John Sakles, Raj Joshi, Jeremy Greenberg & Jarrod Mosier

  3. University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ, 85724, USA

    Harsharon Chopra

Authors
  1. Cameron Hypes
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  2. John Sakles
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  3. Raj Joshi
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  4. Jeremy Greenberg
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  5. Bhupinder Natt
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  6. Josh Malo
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  7. John Bloom
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  8. Harsharon Chopra
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  9. Jarrod Mosier
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Corresponding author

Correspondence to Jarrod Mosier.

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Conflicts of interest

Dr. Sakles serves on the scientific advisory committee for Verathon Medical.

Statement of human and animal rights

This study was reviewed and approved by the University of Arizona Institutional Review Board.

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This study was granted exemption from informed consent.

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Hypes, C., Sakles, J., Joshi, R. et al. Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications. Intern Emerg Med 12, 1235–1243 (2017). https://doi.org/10.1007/s11739-016-1549-9

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  • DOI: https://doi.org/10.1007/s11739-016-1549-9

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