Emergency Endotracheal Intubation and Factors Affecting Success Rate

Year 2019, Volume: 3 Issue: 3, 72 - 78, 03.12.2019

Fatma Çelik

Abstract

ABSTRACT

Emergency endotracheal
intubation is a life-saving intervention that must be intervened without
necessarily providing ideal conditions and is the gold standard for emergency
airway management. It is inevitable that the success rates of emergency
endotracheal intubation performed under unfavorable conditions outside the
operating room are low. Some factors associated with the success of emergency
endotracheal intubation can be predicted and modified to improve outcome. In
this article; the importance of achieving successful emergency endotracheal
intubation in the first attempt and systematic use of the factors affecting the
success rate will be reviewed in the light of current literature.

Factors to be evaluated
include; critical value for life of emergency endotracheal intubation in
non-operating room settings, qualifications of intubation team, emergency
patient and airway evaluation, preparation, position, preoxygenation and peroxygenation,
avoidance of desaturation, safe apnea time, emergency endotracheal intubation
methods and equipment.

Keywords

Airway management, emergency intubation, endotracheal intubation, laryngoscope, video-laryngoscopy

Acil Endotrakeal Entübasyon ve Başarı Oranını Etkileyen Faktörler

Abstract

ÖZ

Acil endotrakeal entübasyon, zorunlu olarak ideal koşullar
sağlanamadan, müdahale edilmesi gereken hayat kurtarıcı bir girişimdir ve acil
havayolu yönetimi için altın standarttır. Ameliyathane dışında elverişsiz
koşullar altında yapılan acil endotrakeal entübasyon başarı oranlarının düşük
olması kaçınılmazdır. Acil endotrakeal entübasyon başarısı ile ilişkili bazı
faktörler tahmin edilebilir ve sonucu iyileştirmek için değiştirilebilir. Bu
makalede; başarılı acil endotrakeal entübasyonu ilk girişimde sağlayabilmenin
önemi ve başarı oranını etkileyen faktörlerin sistematik kullanımı güncel
literatürler ışığında gözden geçirilecektir.

Değerlendirme yapılacak faktörler arasında; ameliyathane dışı
ortamlarda acil endotrakeal entübasyon yapılmasının yaşam için kritik değeri,
entübasyon ekibinin nitelikleri, acil hasta ve havayolu değerlendirme,
hazırlık,  pozisyon, preoksijenizasyon ve
peroksijenizasyon, desatürasyondan kaçınma, güvenli apne zamanı, acil
endotrakeal entübasyon yöntemleri ve ekipman yer almaktadır.

Keywords

Havayolu yönetimi, acil entübasyon, endotrakeal entübasyon, laringoskop, videolaringoskopi

References

• Pavlov I, Medrano S, Weingart S. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. Am J Emerg Med. 2017;35(8):1184-1189.
• Brindley PG, Beed M, Law JA, et al. Airway management outside the operating room: how to better prepare. Can J Anaesth. 2017;64(5):530-539.
• Soar J, Nolan JP, Bottiger BW, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015;95:100-147.
• Mechlin MW, Hurford WE. Emergency tracheal intubation: techniques and outcomes. Respir Care. 2014;59(6):881-892.
• Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607-613.
• Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106(5):632-642.
• Carın A, Hagberg CAA. Airway Management in the Adult. In: Miller RD, ed. Miller's Anesthesia. Vol 2. 8th ed. 2015:1647-1683. Available from: Erişim tarihi: 27 Mart 2019 https://anesthesia.tw/quizbank/lib/exe/fetch.php/reference:miller8e:chapter_55_1647-1683.e5.pdf
• Klosiewicz T, Zalewski R, Dabrowska A, Maciejewski A. Emergency intubation in prehospital care. Am J Emerg Med. 2017;35(11):1775-1776.
• Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120(2):323-352. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827-848.
• Driver BE, Reardon R.F. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. In: Roberts JR, ed. Tracheal Intubation. 7th ed. 2018:62-110.
• Ramkumar V, Umesh G, Philip, F.A. . Preoxygenation with 20º head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. Journol of Anesthesia. 2011;25(2):189-194.
• Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165-175 e161.
• Khandelwal N, Khorsand S, Mitchell SH, Joffe AM. Head-Elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Anesth Analg. 2016;122(4):1101-1107.
• Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. Br J Anaesth. 2007;99(4):581-586.