Intensive Care Medicine

, Volume 34, Issue 10, pp 1835–1842 | Cite as

Complications of endotracheal intubation in the critically ill

  • Donald E. G. GriesdaleEmail author
  • T. Laine Bosma
  • Tobias Kurth
  • George Isac
  • Dean R. Chittock



Assess the risk of complications during endotracheal intubation (ETI) and their association with the skill level of the intubating physician.


Prospective cohort study of 136 patients intubated by the intensive care team during a 5-month period. Standardized data forms were used to collect detailed information on the intubating physicians, supervisors, techniques, medications and complications.


Canadian academic intensive care unit.

Measurements and results

All intubations were successful and there were no deaths during intubation. Non-experts were supervised in 92% of procedures. Expert operators were successful within two attempts in 94%, compared to only 82% of non-experts (P = 0.03), with 13.2% of all intubations requiring ≥3 attempts. Furthermore, 10.3% of intubations required 10 or more minutes. Difficult intubation (3 or more attempts by an expert) occurred in 6.6%. Overall risk of complications was 39%, including: severe hypoxemia (19.1%), severe hypotension (9.6%), esophageal intubation (7.4%) and frank aspiration (5.9%). ICU and hospital mortality were 15.4 and 29.4%, respectively. Compared with non-expert intubating physicians, propensity score-adjusted odds ratios (95% confidence interval) for expert physicians were 0.92 (95% CI: 0.28, 3.05, P = 0.89) for any complication, 0.45 (95% CI: 0.09, 2.20, P = 0.32) for ICU mortality and 0.47 (95% CI: 0.13, 1.70, P = 0.25) for hospital mortality. Two or more attempts at ETI was independently associated with an increased risk of severe complications (OR 3.31, 95% CI: 1.30, 8.40, P = 0.01).


These prospective data show a high risk of serious complications, and difficult intubations, that are associated with ETI of the critically ill.


Artificial airways and complications.


Intubation, intratracheal Complications Critical care Propensity score 



We gratefully acknowledge Ms. Shelly Fleck-McCaskill for her invaluable assistance with data acquisition. We also thank the Respiratory Therapists and Nurses at Vancouver General Hospital for their support of this project.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Donald E. G. Griesdale
    • 1
    • 2
    • 3
    Email author
  • T. Laine Bosma
    • 1
  • Tobias Kurth
    • 4
  • George Isac
    • 1
    • 2
    • 3
  • Dean R. Chittock
    • 3
  1. 1.Department of Anesthesiology, Pharmacology and TherapeuticsUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Anesthesia, Critical Care MedicineVancouver General HospitalVancouverCanada
  3. 3.Department of Medicine, Division of Critical Care MedicineUniversity of British Columbia and Program of Critical Care Medicine, Vancouver General HospitalVancouverCanada
  4. 4.Department of Epidemiology, Harvard School of Public Health and Divisions of Preventive Medicine and Aging, Department of MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

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