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In and Out of ICU Intubation Technique and Complication Rates
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A5136 - In and Out of ICU Intubation Technique and Complication Rates
Author Block: F. Mastroianni1, N. Emami1, L. Eisen2, A. Shiloh2, D. G. Fein3; 1Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States, 2Division of Critical Care Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States, 3Division of Pulmonary Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States.
RATIONALE
Although video laryngoscopy (VL) has been previously investigated for emergent endotracheal intubation (EEI) within the confines of an intensive care unit (ICU), the use of this technology on regular hospital floors outside the ICU (OICU) has not been examined. We hypothesized that given the often chaotic nature of EEI in critically ill patients OICU, the use of VL as a primary modality for EEI would be higher, that it might be more likely to be utilized as a backup after direct laryngoscopy (DL) failure and that it’s complication rate would be comparable to DL under these circumstances.
METHODS
We performed a retrospective examination of all patients admitted to our institution between May 2016 and May 2017 who underwent emergent endotracheal intubation (EEI) by the critical care medicine (CCM) service of our hospital. Data was extracted using Looking Glass (Clinical Analytics®, NY, NY) from electronic intubation notes regarding patient demographics and specifics of the EEI procedure. Examined complications were hypotension (defined as newly requiring vasopressors during the procedure anytime after sedative administration), aspiration of gastric contents, esophageal intubation or death. Outcomes were compared using chi-square testing with STATA (StataCorp, College Station, TX).
RESULTS
Nine hundred and ninety eight EEI were done by CCM (477 OICU, 521 ICU) during the examined time period for which 976 had complete data to be included in the final analysis. 812 patients were intubated with the primary modality of DL, 161 with VL and 3 with bronchoscopy. For first attempt at EEI, VL was used as frequently OICU as in the ICU (15.3% vs 17.7%; p = 0.30). VL was as likely to be used after DL failure OICU as in the ICU (6.9% vs 9.8%; p = 0.129). There was no difference in complication rates between VL and DL as the initial device during EEI events OICU (4.2% vs 9.6%; p = 0.138).
CONCLUSION
At our institution, VL is as likely to be used as a primary tool for EEI OICU as in the ICU and is no more likely to be used as a backup device following DL failure OICU as in the ICU. When performed by critical care fellows or attending physicians, the rate of complications for EEI OICU is similar for VL and DL. Further investigation is needed into the role of VL to aid in EEI of critically ill patients OICU.
Author Block: F. Mastroianni1, N. Emami1, L. Eisen2, A. Shiloh2, D. G. Fein3; 1Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States, 2Division of Critical Care Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States, 3Division of Pulmonary Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States.
RATIONALE
Although video laryngoscopy (VL) has been previously investigated for emergent endotracheal intubation (EEI) within the confines of an intensive care unit (ICU), the use of this technology on regular hospital floors outside the ICU (OICU) has not been examined. We hypothesized that given the often chaotic nature of EEI in critically ill patients OICU, the use of VL as a primary modality for EEI would be higher, that it might be more likely to be utilized as a backup after direct laryngoscopy (DL) failure and that it’s complication rate would be comparable to DL under these circumstances.
METHODS
We performed a retrospective examination of all patients admitted to our institution between May 2016 and May 2017 who underwent emergent endotracheal intubation (EEI) by the critical care medicine (CCM) service of our hospital. Data was extracted using Looking Glass (Clinical Analytics®, NY, NY) from electronic intubation notes regarding patient demographics and specifics of the EEI procedure. Examined complications were hypotension (defined as newly requiring vasopressors during the procedure anytime after sedative administration), aspiration of gastric contents, esophageal intubation or death. Outcomes were compared using chi-square testing with STATA (StataCorp, College Station, TX).
RESULTS
Nine hundred and ninety eight EEI were done by CCM (477 OICU, 521 ICU) during the examined time period for which 976 had complete data to be included in the final analysis. 812 patients were intubated with the primary modality of DL, 161 with VL and 3 with bronchoscopy. For first attempt at EEI, VL was used as frequently OICU as in the ICU (15.3% vs 17.7%; p = 0.30). VL was as likely to be used after DL failure OICU as in the ICU (6.9% vs 9.8%; p = 0.129). There was no difference in complication rates between VL and DL as the initial device during EEI events OICU (4.2% vs 9.6%; p = 0.138).
CONCLUSION
At our institution, VL is as likely to be used as a primary tool for EEI OICU as in the ICU and is no more likely to be used as a backup device following DL failure OICU as in the ICU. When performed by critical care fellows or attending physicians, the rate of complications for EEI OICU is similar for VL and DL. Further investigation is needed into the role of VL to aid in EEI of critically ill patients OICU.
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