Journal of Anesthesia

, Volume 32, Issue 2, pp 153–159 | Cite as

Impact of intervention time on hospital survival in patients requiring emergent airway management: a preliminary study

  • Kuo-Chuan Hung
  • Hsiu-Jung Lin
  • Shao-Wei Hsieh
  • Cheuk-Kwan Sun
Original Article
  • 64 Downloads

Abstract

Background

The time in the day of intervention for physiological deterioration reportedly impacts patient outcomes. This study aimed at determining the impact of the time of ETI on hospital survival in critically ill patients.

Methods

Between January 2014 and December 2016, 151 patients who underwent emergency tracheal intubation (ETI) by the airway response team (ART) in the general wards of a tertiary referral center were retrospectively reviewed. Patients were divided into two groups based on the time of ETI (daytime group, 8:00 a.m.–4:00 p.m., n = 57, mean age 63.5 ± 14.1 years; nighttime group, 4:00 p.m.–8:00 a.m., n = 94, mean age 60.4 ± 14.9 years). Data regarding demographic information, comorbidities, trigger events for intubation, survival-to-discharge rates, acute physiology and chronic health evaluation II (APACHE II), ventilator-free days, and airway techniques were collected.

Results

There was no significant difference in sex, age, body mass index, APACHE II, or comorbidities between the two groups, except that a higher proportion of patients presented with arrhythmias (21.1 vs. 8.5%, p = 0.028) and received fiberoptic intubation (24.6 vs. 11.7%, p = 0.039) in the daytime group than in the nighttime group. The time of the ART arrival after call was also shorter in daytime than that in nighttime (6.1 ± 1.4 vs. 10.5 ± 3.2 min, respectively, p < 0.001). There were no differences in the survival-to-discharge rate (45.6 vs. 43.6%, p = 0.811), ventilator-free days, or trigger events between the two groups.

Conclusions

Emergent tracheal intubation in the nighttime may not have negative impact on the survival-to-discharge rate compared with that performed in the daytime.

Keywords

Tracheal intubation Hospital survival Airway response team 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

References

  1. 1.
    Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med. 2001;345:663–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Aylin P, Yunus A, Bottle A, Majeed A, Bell D. Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Health Care. 2010;19:213–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Morales IJ, Peters SG, Afessa B. Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med. 2003;31:858–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Dominguez-Rodriguez A, Garcia-Gonzalez M, Abreu-Gonzalez P. Outcome of primary angioplasty for ST-segment elevation myocardial infarction during routine duty hours versus during off-hours. Results of a single-center in Spain. Int J Cardiol. 2007;119:227–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Henriques JP, Haasdijk AP, Zijlstra F, Zwolle Myocardial Infarction Study Group. Outcome of primary angioplasty for acute myocardial infarction during routine duty hours versus during off-hours. J Am Coll Cardiol. 2003;41:2138–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Saleem MA, Kannam H, Aronow WS, Weiss MB, Kalapatapu K, Pucillo AL, Monsen CE. The effects of off-normal hours, age, and gender for coronary angioplasty on hospital mortality in patients undergoing coronary angioplasty for acute myocardial infarction. Am J Cardiol. 2004;93:763–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Robinson EJ, Smith GB, Power GS, Harrison DA, Nolan J, Soar J, Spearpoint K, Gwinnutt C, Rowan KM. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study. BMJ Qual Saf. 2016;25:832–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Herlitz J, Bång A, Alsén B, Aune S. Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. Resuscitation. 2002;53:127–33.CrossRefPubMedGoogle Scholar
  9. 9.
    Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–48.CrossRefPubMedGoogle Scholar
  10. 10.
    Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF. The working hours of hospital staff nurses and patient safety. Health Aff (Millwood). 2004;23:202–12.CrossRefGoogle Scholar
  11. 11.
    Muller JE, Stone PH, Turi ZG, Rutherford JD, Czeisler CA, Parker C, Poole WK, Passamani E, Roberts R, Robertson T, Sobel BE, Willerson JT, Braunwald E, MILIS Study Group. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med. 1985;313:1315–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Amaravadi RK, Dimick JB, Pronovost PJ, Lipsett PA. ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy. Intensive Care Med. 2000;26:1857–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Sakai T, Devita MA. Rapid response system. J Anesth. 2009;23:403–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H, Gutteridge G. Long term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care. 2005;9:R808–15.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3,423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011;114:42–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Henderson SO, McClung CD, Sintuu C, Swadron SP. The presence of an Emergency Airway Response Team and its effects on in-hospital Code Blue. J Emerg Med. 2009;36:116–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMedGoogle Scholar
  18. 18.
    Schoenfeld DA, Bernard GR, ARDS Network. Statistical evaluation of ventilator-free days as an efficacy measure in clinical trials of treatments for acute respiratory distress syndrome. Crit Care Med. 2002;30:1772–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103:429–37.CrossRefPubMedGoogle Scholar
  20. 20.
    Weinger MB, Vredenburgh AG, Schumann CM, Macario A, Williams KJ, Kalsher MJ, Smith B, Truong PC, Kim A. Quantitative description of the workload associated with airway management procedures. J Clin Anesth. 2000;12:273–82.CrossRefPubMedGoogle Scholar
  21. 21.
    Reznick RK, Folse JR. Effect of sleep deprivation on the performance of surgical residents. Am J Surg. 1987;154:520–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Robbins J, Gottlieb F. Sleep deprivation and cognitive testing in internal medicine house staff. West J Med. 1990;152:82–6.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified early warning score in medical admissions. QJM. 2001;94:521–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, Constantin JM. Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care. 2015;19:257.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Khandelwal N, Galgon RE, Ali M, Joffe AM. Cardiac arrest is a predictor of difficult tracheal intubation independent of operator experience in hospitalized patients. BMC Anesthesiol. 2014;14:38.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364:1037–45.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyChi Mei Medical CenterYungKung DistrictTaiwan, ROC
  2. 2.Department of AnesthesiologyE-DA HospitalKaohsiungTaiwan, ROC
  3. 3.Department of Anesthesiology, Beigang HospitalChina Medical UniversityYunlinTaiwan, ROC
  4. 4.Department of Emergency Medicine, E-Da Hospital, School of Medicine for International StudentsI-Shou UniversityKaohsiungTaiwan, ROC

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