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Complications of endotracheal intubation in the critically ill

Intensive Care Medicine volume 34, pages 1835–1842 (2008)Cite this article

Abstract

Objective

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

Design

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.

Setting

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).

Conclusions

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

Descriptor

Artificial airways and complications.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada

    Donald E. G. Griesdale, T. Laine Bosma & George Isac

  2. Department of Anesthesia, Critical Care Medicine, Vancouver General Hospital, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, V5Z 1M9, BC, Canada

    Donald E. G. Griesdale & George Isac

  3. Department of Medicine, Division of Critical Care Medicine, University of British Columbia and Program of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada

    Donald E. G. Griesdale, George Isac & Dean R. Chittock

  4. Department of Epidemiology, Harvard School of Public Health and Divisions of Preventive Medicine and Aging, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Tobias Kurth

Authors
  1. Donald E. G. Griesdale
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  2. T. Laine Bosma
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  3. Tobias Kurth
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  4. George Isac
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Correspondence to Donald E. G. Griesdale.

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Griesdale, D.E.G., Bosma, T.L., Kurth, T. et al. Complications of endotracheal intubation in the critically ill. Intensive Care Med 34, 1835–1842 (2008). https://doi.org/10.1007/s00134-008-1205-6

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  • DOI: https://doi.org/10.1007/s00134-008-1205-6

Keywords

  • Intubation, intratracheal
  • Complications
  • Critical care
  • Propensity score