Challenges and Advances in Intubation: Rapid Sequence Intubation

Mace, Sharon E.

doi:10.1016/j.emc.2008.10.002

Cited by 52 publications

(62 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A possible explanation may be that pre-hospital RSI typically allows more time for preparations including optimal positioning of the patient before attempting PHETI compared with for instance PHETI attempts on cardiac arrest patients. Furthermore, the use of NMBAs is known to facilitate intubation success [26] and the incidence of non-RSI drug assisted PHETI in our study may be unjustifiably high. Our results suggest a need for approved first-pass success during PHETI in our system.…”

Section: Discussionmentioning

confidence: 84%

Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study

Rognås

Hansen

Kirkegaard

et al. 2013

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

IntroductionWe report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management.Materials and methodsAnaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1st 2011 to October 31st 2012. Included were patients of all ages on whom pre-hospital advanced airway management was performed. The objective was to estimate the incidences of failed and difficult pre-hospital endotracheal intubation, and complications related to pre-hospital advanced airway management.ResultsThe overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%, even though 22.4% of pre-hospital endotracheal intubations required more than one intubation attempt. The overall incidence of complications related to pre-hospital advanced airway management was 7.9%. Following rapid sequence intubation, the incidence of first pass success was 85.8%, the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased overall incidence of complications. No airway management related deaths occurred.DiscussionThe overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. The incidence of pre-hospital endotracheal intubations requiring more than one attempt is higher than suspected. The incidence of hypotension or hypoxia after pre-hospital rapid sequence intubation compares to those found in UK emergency departments.ConclusionPre-hospital advanced airway management including pre-hospital endotracheal intubation performed by experienced anaesthesiologists is associated with high success rates and relatively low incidences of complications. An increased first pass success rate following pre-hospital endotracheal intubation may further reduce the incidence of complications and enhance patient safety in our system.

show abstract

Section: Discussionmentioning

confidence: 84%

Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study

Rognås

Hansen

Kirkegaard

et al. 2013

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…Earlier, Hodges et al 36 used only 50 mg succinylcholine with no pretreatment after rapid IV injection of thiopental in obstetric patients. 43 After a 1 mg/kg dose, excellent ICs were found in only 63% to 80% of patients; acceptable ICs (which may be associated with some diaphragmatic reaction or extremity movement) were found in 92% to 98% of patients, and the remainder were unacceptable ICs. However, most of the studies that followed these initial reports considered the "gold standard" dose to be 1 mg/kg without curare pretreatment and 1.5 mg/kg when curare is used to prevent fasciculations.…”

Section: Succinylcholine: the Optimal Dosementioning

confidence: 93%

Rapid Sequence Induction and Intubation

El-Orbany

Connolly

2010

Anesthesia &Amp; Analgesia

209

152

View full text Add to dashboard Cite

The changing opinion regarding some of the traditional components of rapid sequence induction and intubation (RSII) creates wide practice variations that impede attempts to establish a standard RSII protocol. There is controversy regarding the choice of induction drug, the dose, and the method of administration. Whereas some prefer the traditional rapid injection of a predetermined dose, others use the titration to loss of consciousness technique. The timing of neuromuscular blocking drug (NMBD) administration is different in both techniques. Whereas the NMBD should immediately follow the induction drug in the traditional technique, it is only given after establishing loss of consciousness in the titration technique. The optimal dose of succinylcholine is controversial with advocates and opponents for both higher and lower doses than the currently recommended 1.0 to 1.5 mg/kg dose. Defasciculation before succinylcholine was traditionally recommended in RSII but is currently controversial. Although the priming technique was advocated to accelerate onset of nondepolarizing NMBDs, its use has decreased because of potential complications and the introduction of rocuronium. Avoidance of manual ventilation before tracheal intubation was traditionally recommended to avoid gastric insufflation, but its use is currently acceptable and even recommended by some to avoid hypoxemia and to "test" the ability to mask ventilate. Cricoid pressure remains the most heated controversy; some believe in its effectiveness in preventing pulmonary aspiration, whereas others believe it should be abandoned because of the lack of scientific evidence of benefit and possible complications. There is still controversy regarding the best position and whether the head-up, head-down, or supine position is the safest during induction of anesthesia in full-stomach patients. These controversial components need to be discussed, studied, and resolved before establishing a standard RSII protocol.

show abstract

“…A small subset of critically ill patients requires the provision of general anaesthesia within an emergency department . This is usually achieved by rapid sequence intubation, which involves administration of sedative medication(s) and a paralysing agent, to facilitate passage of an endotracheal tube to achieve airway control and ventilation . This critical intervention requires careful judgement in order to maintain patient physiology, and the ideal induction regimen has not been defined.…”

Section: Introductionmentioning

confidence: 99%

FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol

Ferguson

Milligan

Buttfield

et al. 2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background Some critically ill patients require rapid sequence intubation in the emergency department, and ketamine is one sedative agent employed, due to its relative haemodynamic stability. Tachycardia and hypertension are frequent side effects, and in less stable patients, shock can be unmasked or exacerbated. The use of fentanyl as a co‐induction agent may lead to a smoother haemodynamic profile post‐induction, which may lead to reduced mortality in this critically ill cohort. This randomised controlled trial aims to compare the effect of administering fentanyl vs placebo in a standardised induction regimen with ketamine and rocuronium on (a) the percentage of patients in each group with a systolic blood pressure outside the range of 100‐150 mm Hg within 10 minutes of induction, (b) the laryngoscopic view, and (c) 30‐day mortality. Methods/design Three hundred patients requiring rapid sequence intubation in participating emergency departments will be randomised to receive either fentanyl or placebo (0.9% saline) in addition to ketamine and rocuronium according to a standardised, weight‐based induction regimen. The primary outcome measure is the percentage of patients in each group with a systolic blood pressure outside the range of 100‐150 mm Hg within 10 minutes of induction. Secondary outcome measures include the laryngoscopic view, percentage of first pass success, 30‐day mortality and number of ventilator‐free days at 30 days. Discussion The effect of adding fentanyl to an induction regimen of ketamine and rocuronium will be evaluated, both in terms of post‐intubation physiology, the effect on intubating conditions, and 30‐day mortality.

show abstract

Challenges and Advances in Intubation: Rapid Sequence Intubation

Cited by 52 publications

References 40 publications

Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study

Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study

Rapid Sequence Induction and Intubation

FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol

Contact Info

Product

Resources

About