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Intubation - Are Intensivists and Anesthesiologists Different? But Lesson Learned Is the Same?
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A5135 - Intubation - Are Intensivists and Anesthesiologists Different? But Lesson Learned Is the Same?
Author Block: A. Naeem1, I. Ratnani2, R. Ishtiaq3; 1Maricopa Medical Center, Phoenix, AZ, United States, 2Anesthesiology, Houston Methodist Hospital, Houston, TX, United States, 3Houston Methodist Hospital, Houston, TX, United States.
Introduction/Hypothesis:Anecdotal observations have shown that there exists a difference between how an airway is approached by intensivists and anesthesiologists. We hypothesized that background training and different OR vs ICU environments may play a role for this difference. Our secondary goal was to obtain one golden lesson learned from combining over 100 years of clinical experience in ""intubation"".
Methods:Using a standardized questionnaire, we interviewed five anesthesiologists and five intensivists, each with more than ten years of clinical experience (50 years of combined experience in each arm). The study was conducted in a Cardiothoracic OR and a post-op Cardiovascular Intensive Care Unit (CVICU) of a tertiary medical center.
Results:Our results shows that, intensivists take visual morbid obesity as a first sign (n = 5/5) but anesthesiologists consider Mallampati score as a first sign of anticipating potential difficult intubation (n = 5/5). Anesthesiologists group considered proper positioning as a key to successful intubations but intensivists considered proper planning (n=3) as a key factor for successful intubation (n = 4). For intensivists bilateral breath sounds tend to be a first sign of successful intubation but anesthesiologists prefer to see positive End-Tidal CO2 as an indicator of a successful intubation (n = 4 vs 4). Direct visualization of endotracheal tube through cord was considered as a sign of successful intubation by one each in both group (n = 1 vs 1). Interestingly, in our survey anesthesiologists tends to call for back up help earlier in case of difficult intubation than intensivists (n=3 vs 2). Video laryngoscope was considered necessary and should be made part of standard care more by intensivists than anesthesiologists (n = 5 vs 1). All responders in each group overwhelmingly advise not to underestimate any airway (n=5/5).
Conclusions:Anesthesiologists and intensivists may tend to differ in their approach to 'intubation' due to training, practice or environment. But, 100 years of combined clinical experience have one golden lesson learned i.e. not to underestimate any single airway.
Keywords:airway management
anesthesia/anesthesiology
education
intensivist
intubation
quality and patient safety
Author Block: A. Naeem1, I. Ratnani2, R. Ishtiaq3; 1Maricopa Medical Center, Phoenix, AZ, United States, 2Anesthesiology, Houston Methodist Hospital, Houston, TX, United States, 3Houston Methodist Hospital, Houston, TX, United States.
Introduction/Hypothesis:Anecdotal observations have shown that there exists a difference between how an airway is approached by intensivists and anesthesiologists. We hypothesized that background training and different OR vs ICU environments may play a role for this difference. Our secondary goal was to obtain one golden lesson learned from combining over 100 years of clinical experience in ""intubation"".
Methods:Using a standardized questionnaire, we interviewed five anesthesiologists and five intensivists, each with more than ten years of clinical experience (50 years of combined experience in each arm). The study was conducted in a Cardiothoracic OR and a post-op Cardiovascular Intensive Care Unit (CVICU) of a tertiary medical center.
Results:Our results shows that, intensivists take visual morbid obesity as a first sign (n = 5/5) but anesthesiologists consider Mallampati score as a first sign of anticipating potential difficult intubation (n = 5/5). Anesthesiologists group considered proper positioning as a key to successful intubations but intensivists considered proper planning (n=3) as a key factor for successful intubation (n = 4). For intensivists bilateral breath sounds tend to be a first sign of successful intubation but anesthesiologists prefer to see positive End-Tidal CO2 as an indicator of a successful intubation (n = 4 vs 4). Direct visualization of endotracheal tube through cord was considered as a sign of successful intubation by one each in both group (n = 1 vs 1). Interestingly, in our survey anesthesiologists tends to call for back up help earlier in case of difficult intubation than intensivists (n=3 vs 2). Video laryngoscope was considered necessary and should be made part of standard care more by intensivists than anesthesiologists (n = 5 vs 1). All responders in each group overwhelmingly advise not to underestimate any airway (n=5/5).
Conclusions:Anesthesiologists and intensivists may tend to differ in their approach to 'intubation' due to training, practice or environment. But, 100 years of combined clinical experience have one golden lesson learned i.e. not to underestimate any single airway.
Keywords:airway management
anesthesia/anesthesiology
education
intensivist
intubation
quality and patient safety
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