Intensive Care Medicine

, Volume 36, Issue 2, pp 248–255 | Cite as

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

  • Samir JaberEmail author
  • Boris Jung
  • Philippe Corne
  • Mustapha Sebbane
  • Laurent Muller
  • Gerald Chanques
  • Daniel Verzilli
  • Olivier Jonquet
  • Jean-Jacques Eledjam
  • Jean-Yves Lefrant



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


Two-phase, prospective, multicenter controlled study.


Three medical-surgical ICUs in two university hospitals.


Two hundred three consecutive ICU patients required 244 intubations.


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).


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


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



The authors wish to thank all the personnel of the intensive care units who participated in the implementation of these intubation guidelines. They are grateful to Patrick McSweeny for his English editing and Emmanuel Marret for statistical help.

Conflict of interest statement

Support was provided solely from institutional and/or departmental sources.

Supplementary material

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


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Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Samir Jaber
    • 1
    Email author
  • Boris Jung
    • 1
    • 2
  • Philippe Corne
    • 2
  • Mustapha Sebbane
    • 1
  • Laurent Muller
    • 3
  • Gerald Chanques
    • 1
  • Daniel Verzilli
    • 1
  • Olivier Jonquet
    • 2
  • Jean-Jacques Eledjam
    • 1
  • Jean-Yves Lefrant
    • 3
  1. 1.Intensive Care Unit, Anesthesia and Critical Care Department B: DAR B, CHU de Montpellier, Saint Eloi Teaching HospitalUniversité Montpellier 1Montpellier Cedex 5France
  2. 2.Service de Réanimation Médicale Assistance Respiratoire, CHU de MontpellierHôpital Gui-de-ChauliacMontpellier Cedex 5France
  3. 3.Fédération Anesthésie-Douleur-Urgences-Réanimation, Groupe Hospitalo-Universitaire CaremeauCentre Hospitalier Universitaire NîmesNîmes Cedex 9France

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