Prospective Observational Study of The Endotracheal Intubation Complications in Emergency Department

Year 2021, Volume: 38 Issue: 4, 678 - 681, 09.10.2021

Gökhan Taş Abdullah Algın Serdar Özdemir Mehmet Erdoğan

Abstract

Endotracheal intubation is the gold standard intervention for emergency airway management. Complications related to endotracheal intubation are numerous and frequent.
Complications were identified as being related to endotracheal intubation in our study: hypoxia, hypotension, dysrhythmia, cardiac arrest, hypertension, tachycardia, bradycardia, regurgitation and aspiration of stomach contents, endobronchial intubation, and incorrect positioning of the endotracheal tube in either the esophagus or hypopharynx. The study included 186 patients that were over 18, intubated. The complication rate associated with endotracheal intubation was found to be over 50%. Patients included in our prospective, observational study were all initially evaluated in our ED. A survey was filled out at a time as soon as possible after intubation to record the personnel in charge of intubation, details of the procedure, and hemodynamic changes and complications. Our study found that the following factors were associated with increased rates of complication in intubated patients: history of acute renal failure, history of cancer, GCS < 8, midazolam use during intubation, history of trauma, crash intubation, history of shock, history of cardiac arrest, resident with <1 year of experience carrying out the intubation, residents with 2+ years of experience and specialists carrying out the intubation, history of respiratory failure, and patient age <65.
In order to better understand which patients were likely to be affected by complications associated with intubation, as well as to understand which precautions to take, this study aims to investigate the aggravating factors and complication rates of endotracheal intubation.

Keywords

Airway Management, Intubation, Rapid Sequence Induction and Intubation

References

• 1- J. C. Sakles, J. M. Deacon, A. E. Bair, S. M. Keim, E.A. Panacek, “Delayed complications of emergency airway management: A study of 533 emergency department intubations,” West J emerg med. 2008 nov; 9(4): 190–194.
• 2- M. Bernhard, T. K. Becker, A. Gries, J. Knapp, V. Wenzel, “The first shot is often the best shot: first-pass intubation success in emergency airway management,” Anesthesia&Analgesia: november 2015 vol. 121 issue 5 p 1389–1393.
• 3- T. Fogg, N. Annesley, K. Hitos, J. Vassiliadis, “Prospective observational study of the practice of endotracheal intubation in the emergency department of a tertiary hospital in Sydney, Australia,” Emergency medicine australasia (2012) 24, 617–624.
• 4- D. E. G. Griesdalet, T. L. Bosma, T. Kurth, G. Isac, D. R. Chittock, “Complications of endotracheal intubation in the critically ill,” Intensive care medicine october 2008, vol. 34, issue 10, pp 1835–1842.
• 5- G. D. Simpson, M. J. Ross, D. W. Mckeown, D. C. Ray, “Tracheal intubation in the critically ill: A multi-centre national study of practice and complications,” British journal of anaesthesia, vol. 108, issue 5, may 2012, p 792–799.
• 6- T. C. Mort, “Complications of emergency tracheal intubation: Immediate airway-related consequences: part II,” Intensive care med. 2007 jul-Aug;22(4):208-15.
• 7- W. Y. Kim, M. K. Kwak, B. S. Ko, J. C. Yoon, C. H. Sohn, K. S. Lim, L. W. Andersen, M. W. Donnino, “Factors associated with the occurrence of cardiac arrest after emergency tracheal intubation in the emergency department,” Plos one. 2014 nov 17;9(11):E112779.
• 8- J.F. Dyett, “Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne,” Orjinal papers, Anaesth intensive care 2015; 43:5.
• 9- A. Caltık, “Çocuk yoğun bakımda hastalarında endotrekeal entübasyon deneyimleri,” Araştırma yazısı, Ankara üniversitesi tıp fakültesi mecmuası 2006; 59:93-97.
• 10- M.J. Sagarin, “Airway management by us and canadian emergency medicine residents: A multicenter analysis of more than 6,000 endotracheal intubation attempts,” Ann emerg med. 2005;46(4):328-36.
• 11- S. Nasir, L. Shehbaz, H. Raza, S. Basar, “Endotracheal intubation procedures; Performed At Accident And Emergency Department At Civil Hospital Karachi Pakistan,”Professional med j 2015;22(11):1509-1513.