3,423 Emergency Tracheal Intubations at a University Hospital

Abstract

ABSTRACTBackground:There are limited outcome data regarding emer-gent nonoperative intubation. The current study wasunder-taken with a large observational dataset to evaluate the inci-dence of difficult intubation and complication rates and todetermine predictors of complications in this setting.Methods:Adult nonoperating room emergent intubations atour tertiary care institution from December 5, 2001 to July 6,2009 were reviewed. Prospectively defined data points includedtime of day, location, attending physician presence, number ofattempts, direct laryngoscopy view, adjuvant use, medications,and complications. At our institution, a senior resident with atleast 24 months of anesthesia training is the first responder for allemergent airway requests. The primary outcome was a compos-ite airway complication variable that included aspiration, esoph-ageal intubation, dental injury, or pneumothorax.Results:A total of 3,423 emergent nonoperating room air-way management cases were identified. The incidence ofdifficult intubation was 10.3%. Complications occurred in4.2%: aspiration, 2.8%; esophageal intubation, 1.3%; dentalinjury, 0.2%; and pneumothorax, 0.1%. A bougie intro-ducer was used in 12.4% of cases. Among 2,284 intubationsperformed by residents, independent predictors of the com-posite complication outcome were as follows: three or moreintubation attempts (odds ratio, 6.7; 95% CI, 3.2–14.2),grade III or IV view (odds ratio, 1.9; 95% CI, 1.1–3.5),general care floor location (odds ratio, 1.9; 95% CI, 1.2–3.0), and emergency department location (odds ratio, 4.7;95% CI, 1.1–20.4).Conclusions:During emergent nonoperative intubation,specific clinical situations are associated with an increasedrisk of airway complication and may provide a starting pointfor allocation of experienced first responders.