Table 1.
Characteristics of the study participants by avoiding neuromuscular blocking agent
| Total n = 411 | Avoiding NMBA n = 46 | Using NMBA n = 365 | p value | |
|---|---|---|---|---|
| Tracheostomy during the ICU stay, n (%) | 61 (14.8) | 16 (34.8) | 45 (12.3) | < 0.001 |
| Adverse events during intubation, n (%) | 98 (23.8) | 8 (17.4) | 90 (24.7) | 0.18 |
| Esophageal intubation, n (%) | 2 (0.5) | 0 (0) | 2 (0.6) | 1.00 |
| Airway injury, n (%) | 7 (1.7) | 1 (2.2) | 6 (1.6) | 0.57 |
| Hypoxemia, n (%) | 23 (5.6) | 3 (6.5) | 20 (5.5) | 0.73 |
| Hypotension, n (%) | 73 (17.8) | 4 (8.7) | 69 (18.9) | 0.10 |
| ICU mortality, n (%) | 17 (4.1) | 3 (6.5) | 14 (3.8) | 0.42 |
| Hospital mortality, n (%) | 74 (18.0) | 12 (26.1) | 62 (17.0) | 0.15 |
| Length of ICU stay (days), median (IQR) | 6 (4–10) | 7.5 (5–12) | 6 (4–10) | 0.09 |
| Length of HP stay (days), median (IQR) | 26 (14–42) | 21 (11–42) | 26 (15–42) | 0.15 |
| Ventilator days, median (IQR) | 4 (2–7) | 5 (3–9) | 4 (2–7) | 0.01 |
| Sex (male), n (%) | 259 (63.0) | 27 (58.7) | 232 (63.6) | 0.52 |
| Age (years), median (IQR) | 70 (55–79) | 74 (61–82) | 69 (55–79) | 0.12 |
| BMI (kg/m2), median (IQR) | 21.9 (19.7–24.4) | 20.7 (17.9–23.2) | 22.1 (19.9–24.6) | 0.006 |
| SOFA score, median (IQR) | 6 (4–9) | 7 (4–10) | 6 (4–9) | 0.14 |
| ISS, median (IQR) | 23.5 (14–34) | 22 (17–26) | 25 (14–34) | 0.94 |
| Underlying disease, n (%) | ||||
| Chronic kidney disease | 15 (3.7) | 2 (4.4) | 13 (3.6) | 0.68 |
| Dialysis | 8 (2) | 2 (4.4) | 6 (1.6) | 0.22 |
| Liver cirrhosis or failure | 24 (5.8) | 2 (4.4) | 22 (6.0) | 0.48 |
| Malignancies | 28 (6.9) | 1 (2.2) | 27 (7.5) | 0.35 |
| Immunosuppressive state | 6 (1.5) | 2 (4.4) | 4 (1.1) | 0.13 |
| Diabetes mellitus | 101 (24.6) | 13 (28.3) | 88 (24.1) | 0.59 |
| Disease group, n (%) | ||||
| Cardiovascular | 19 (4.6) | 11 (23.9) | 8 (2.2) | |
| Pulmonary | 60 (14.6) | 10 (21.7) | 50 (13.7) | |
| Gastrointestinal and liver | 77 (18.7) | 2 (4.4) | 75 (20.6) | |
| Neurogenic | 21 (5.1) | 1 (2.2) | 20 (5.5) | |
| Sepsis (unknown origin or urinary tract infection) | 15 (3.7) | 2 (4.4) | 13 (3.6) | |
| Trauma | 170 (41.4) | 14 (30.4) | 156 (42.7) | |
| Metabolic | 25 (6.1) | 5 (10.9) | 20 (5.5) | |
| Hematology | 1 (0.2) | 0 (0) | 1 (0.3) | |
| Urinary | 8 (2) | 0 (0) | 8 (2.2) | |
| Musculoskeletal | 11 (2.7) | 1 (2.2) | 10 (2.7) | |
| Medical (other) | 3 (0.7) | 0 (0) | 3 (0.8) | |
| Obstetrics and gynecology | 1 (0.2) | 0 (0) | 1 (0.3) | < 0.001 |
| CPA before intubation, n (%) | 16 (3.9) | 14 (30.4) | 2 (0.6) | < 0.001 |
| Reintubation, n (%) | 26 (6.3) | 6 (13) | 20 (5.5) | 0.06 |
| VAP, n (%) | 24 (5.8) | 3 (6.5) | 21 (5.8) | 0.74 |
| Delirium, n (%) | 87 (23.5) | 9 (24.3) | 78 (23.4) | 0.84 |
| Methods and medication of intubation, n (%) | ||||
| No drug | 26 (6.3) | 26 (56.5) | – | |
| Analgesic + sedatives | 20 (4.9) | 20 (43.5) | – | |
| RSI (NMBA + analgesic + sedatives) | 351 (85.4) | – | 351 (96.2) | |
| NMBA | 7 (1.7) | – | 7 (1.9) | |
| NMBA + sedatives | 7 (1.7) | – | 7 (1.9) | < 0.001 |
| Video laryngoscopy, n (%) | 386 (93.9) | 37 (80.4) | 349 (95.6) | 0.001 |
| Abnormal facial shape, n (%) | 23 (5.8) | 4 (8.7) | 19 (5.4) | 0.32 |
| Airway obstruction, n (%) | 8 (2.0) | 5 (10.9) | 3 (0.8) | 0.001 |
| Neck mobility limitation, n (%) | 115 (28.4) | 13 (28.9) | 102 (28.3) | 1.00 |
| Opening mouth limitation, n (%) | 92 (25.9) | 12 (31.6) | 80 (25.2) | 0.43 |
| GCS before intubation, median (IQR) | 13 (7–15) | 3.5 (3–13) | 13 (9–15) | < 0.001 |
| Cormack–Lehane grade, n (%) | ||||
| 1 | 290 (72) | 25 (55.6) | 265 (74) | |
| 2 | 93 (23.1) | 14 (31.1) | 79 (22.1) | |
| 3 | 18 (4.5) | 5 (11.1) | 13 (3.6) | |
| 4 | 2 (0.5) | 1 (2.2) | 1 (0.3) | 0.01 |
| Specialty of the intubator, n (%) | ||||
| Resident (PGY 1, 2) | 72 (17.5) | 5 (10.9) | 67 (18.4) | |
| EM resident (PGY 3–5) | 201 (48.9) | 22 (47.8) | 179 (49.0) | |
| EM fellow or attendinga | 130 (31.6) | 19 (41.3) | 111 (30.4) | |
| Anesthesiologist | 2 (0.5) | 0 (0) | 2 (0.6) | |
| Pediatrician | 6 (1.5) | 0 (0) | 6 (1.6) | 0.53 |
| Multiple attempts, n (%) | 56 (13.6) | 12 (26.1) | 44 (12.1) | 0.02 |
IQR interquartile range, SD standard deviation, NMBA neuromuscular blocking agent, ICU intensive care unit, HP hospital, BMI body mass index, SOFA score Sequential Organ Failure Assessment Score, ISS Injury Severity Score, CPA cardiopulmonary arrest, VAP ventilator associated pneumonia, ARDS acute respiratory distress syndrome, RSI rapid sequence induction, GCS Glasgow Coma Scale, PGY post graduate year, EM emergency medicine
aEM attending included intensivist