Table 4.
Pre-intubation management and intubation characteristics and complications.
|
| |
|---|---|
| CHARACTERISTICa | INTUBATION |
|
| |
| N = 27 | |
|
| |
| Preoxygenation before intubation, n (%) (n = 26) | 26 (100.0%) |
|
| |
| Nasal cannula | 2 (7.7%) |
|
| |
| Non-rebreather mask | 4 (15.4%) |
|
| |
| Simple face mask | 4 (15.4%) |
|
| |
| BiPAP | 2 (7.7%) |
|
| |
| Bag valve mask, passive | 2 (7.7%) |
|
| |
| Bag valve mask, active | 9 (34.6%) |
|
| |
| Other | 3 (11.5%) |
|
| |
| Last vitals prior to intubation | |
|
| |
| Systolic blood pressure, mean ± SD (n = 17) | 132.06 ± 40.70 |
|
| |
| Patient hypotensiveb, n (%) | 3 (17.6%) |
|
| |
| SpO2 (%), mean ± SD (n = 22) | 94.50 ± 7.95 |
|
| |
| SpO2 <90%, n (%) | 3 (13.6%) |
|
| |
| Blood gas obtained, n (%) | 10 (37.0%) |
|
| |
| pH, mean ± SD (n = 7) | 6.99 ± 0.49 |
|
| |
| CO2, mean ± SD (n = 7) | 52.73 ± 23.68 |
|
| |
| Formal difficult airway assessment completed, n (%) | 13 (48.1%) |
|
| |
| Difficult airway anticipatedc,d, n (%) | 10 (37.0%) |
|
| |
| Number of risk factors for difficult airwaye, mean ± SD | 0.89 ± 1.60 |
|
| |
| Operator on initial attempt | |
|
| |
| EM intern | 1 (3.7%) |
|
| |
| EM second-year resident | 16 (59.3%) |
|
| |
| EM third-year resident | 10 (37.0%) |
|
| |
| EM-trained attending | 0 (0.0%) |
|
| |
| Operator on successful attempt (if 1st attempt unsuccessful) | |
|
| |
| Same as initial attempt | 2 (7.4%) |
|
| |
| EM intern or second-year resident | 1 (3.7%) |
|
| |
| EM third-year resident | 6 (22.2%) |
|
| |
| EM-trained attending | 2 (7.4%) |
|
| |
| First-pass success, n (%) (n = 26) | 15 (57.7%) |
|
| |
| Among second-year residents | 9 (60.0%) |
|
| |
| Among third-year residents | 6 (60.0%) |
|
| |
| Total number of attempts, mean ± SD | 1.75 ± 0.94 |
|
| |
| Overall intubation success, n (%) (n = 26) | 26 (100.0%) |
|
| |
| Any induction agent administeredf, n (%) (n = 22) | 19 (86.4%) |
|
| |
| Ketamine | 16 (72.7%) |
|
| |
| Midazolam | 2 (9.1%) |
|
| |
| Propofol | 1 (4.5%) |
|
| |
| Fentanyl | 1 (4.5%) |
|
| |
| Any paralytic agent administeredg, n (%) (n = 22) | 15 (68.2%) |
|
| |
| Succinylcholine | 10 (45.5%) |
|
| |
| Vecuronium | 5 (22.7%) |
|
| |
| Both induction and paralytic agents administered, n (%) (n = 21) | 15 (71.4%) |
|
| |
| Lowest O2 saturation during intubation (%), mean ± SD (n = 23) | 93.61 ± 7.33 |
|
| |
| Lowest O2 saturation <90%, n (%) | 4 (17.4%) |
|
| |
| Any method of intubation confirmationh, n (%) (n = 21) | 21 (100.0%) |
|
| |
| Auscultation | 21 (100.0%) |
|
| |
| Tube condensation | 13 (61.9%) |
|
| |
| Radiography | 2 (9.5%) |
|
| |
| CO2 detector | 0 (0.0%) |
|
| |
| Any complicationi, n (%) (n = 26) | 2 (7.7%) |
|
| |
| Bleeding | 1 (3.8%) |
|
| |
| Hypoxia (SpO2<90%) | 1 (3.8%) |
|
| |
BiPAP, bi-level positive pressure ventilation; SpO2, oxygen saturation; CO2, carbon dioxide.
a For characteristics with missing information, the number of patients with available information is noted in parentheses.
b Hypotension was defined as SBP <100 for age >12 years, <80 for ages 1–12, and <70 for <1 year old.
c Difficult airway was defined as an abnormal LEMON assessment, if LEMON assessment was completed; if assessment was not completed, difficult airway included Mallampati Class III/IV; spinal immobilization; or obese body habitus.
d The LEMON method is an airway assessment defined by the following criteria: Look, Evaluate, Mallampati, Obesity or obstruction, and Neck mobility.
e Risk factors included external evaluation, 3-3-2, Mallampati score (3 or 4), obesity, and neck immobility/spinal immobilization.
f No providers reported using lorazepam, etomidate, or morphine for induction.
g Rocuronium is not available for use at HUM.
h Multiple methods of confirmation could be selected.
i No providers reported complications of direct airway injury, cardiac arrest, cricothyroidotomy, dental trauma, hypotension, or laryngospasm.