Table 3. Techniques, Medications, and Confirmations of Intubations.
| Variable | No. (%) (n = 2964) |
|---|---|
| Application of an airway management protocol | |
| Standard protocol | |
| In place and used | 1510 (51.0) |
| In place and not useda | 443 (15.0) |
| No standard protocol in place | 1009 (34.0) |
| Preoxygenation method (n = 2960) | |
| Bag-valve mask | 1847 (62.4) |
| Standard facemask | 389 (13.2) |
| Noninvasive ventilation | 344 (11.6) |
| High-flow nasal cannula | 160 (5.4) |
| Anesthesia breathing circuitb | 56 (1.9) |
| Continuous positive airway pressure | 51 (1.7) |
| Venturi system | 47 (1.6) |
| Nasal cannula | 47 (1.6) |
| Otherc | 19 (0.6) |
| Apneic oxygenation, No./total (%)d | 308/2959 (10.4) |
| Rapid sequence induction, No./total (%)e | 1727/2777 (62.2) |
| Cricoid pressure, No./total (%) | 1120/2956 (37.9) |
| Induction agent, No./total (%)f | 2774/2964 (93.6) |
| Propofol | 1230 (41.5) |
| Midazolam | 1079 (36.4) |
| Etomidate | 527 (17.8) |
| Ketamine | 421 (14.2) |
| Muscle relaxant use, No./total (%) | 2095/2776 (75.5) |
| Rocuronium | 1239 (41.8) |
| Succinylcholine | 646 (21.8) |
| Vecuronium | 95 (3.2) |
| Cisatracurium | 85 (2.9) |
| Opioid use for intubation, No./total (%) | 1415/2776 (51.0) |
| Method of laryngoscopy (n = 2963) | |
| Direct laryngoscopy with Macintosh or Miller blade | 2416 (81.5) |
| Video laryngoscopy | 505 (17.1) |
| Other methodg | 42 (1.4) |
| Use of intubation adjuncts (n = 1055) | |
| Stylet | 816 (77.4) |
| Bougie | 230 (21.8) |
| Otherh | 9 (0.8) |
| First method used to confirm intubation (n = 2956) | |
| Auscultation | 1711 (57.9) |
| Waveform capnographyi | 758 (25.6) |
| Colorimetric carbon dioxide detectionj | 222 (7.5) |
| Capnometryk | 138 (4.7) |
| None | 7 (0.2) |
| Otherl | 120 (4.1) |
| Success, No./total (%) | |
| First pass | 2360/2958 (79.8) |
| Second pass | 460/2958 (15.6) |
| Emergency front-of-neck accessm | 4 (0.13) |
Standard protocol was not used in intensive care unit (57.3%), emergency department (26.6%), ward (11.5%), and other places (4.51%), including recovery, cardiology, radiology, and endoscopy interventional rooms.
Anesthesia breathing circuits (eg, Mapleson C) are used outside the operating room in some centers instead of self-inflating bags (bag-valve mask). While they require a source of oxygen to work, they provide a lower resistance alternative in spontaneously breathing patients.
Included invasive mechanical ventilation (for patients with self-extubation) and preoxygenation via bag-valve and an extraglottic airway device.
Oxygen administration during laryngoscopy or fiberoscopy.
Rapid onset induction without positive pressure ventilation between induction and laryngoscopy.
Proportion of patients receiving each subcategory of induction agent. Some patients received more than 1 induction drug while others received an opioid as induction agent or underwent awake fiberoptic intubation under local anesthesia.
Included direct laryngoscopy with McCoy blade and fiberoptic intubation. Nasotracheal intubations were performed in 0.8% of patients.
Included tube exchange catheter, lighted stylet, and Magill forceps.
Monitor provided the graphic measurement of exhaled carbon dioxide plotted against time.
Device uses a photochemical reaction to detect the presence of carbon dioxide in the exhaled air.
Provides only the absolute value of carbon dioxide concentration in the exhaled air.
Included chest x-ray and fiberoscopy.
One cricothyroidotomy, 1 percutaneous tracheostomy, and 2 surgical tracheostomies.