Complications of Emergency Tracheal Intubation: Hemodynamic Alterations - Part I

Mort, Thomas C.

doi:10.1177/0885066607299525

Cited by 134 publications

(112 citation statements)

References 77 publications

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“…11,12,19 However, PIHI has received relatively little attention, despite data indicating that hypotension has been associated with poor patient outcomes in other populations with a lower severity of illness and recent data indicating an association between PIHI and patient mortality. 16,17,34 Accordingly, additional hypotension secondary to the EETI procedure in a patient population that is often in a physiologically deranged state may lead to adverse patient outcomes, such as cardiac arrest and multiorgan dysfunction in the short term and prolonged ICU length of stay in the longer term.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10] Adverse events during EETI range from relatively minor (local oropharyngeal soft tissue and dental trauma) to life threatening (dysrhythmias, hypoxia, hemodynamic instability, and cardiac arrest). [11][12][13] Hemodynamic instability in the postintubation phase is a potentially important adverse event associated with EETI that has not been fully described. Although common in clinical resuscitations, postintubation hemodynamic instability (PIHI) has not been consistently reported in studies of EETI.…”

Section: Ré Sumémentioning

confidence: 99%

“…14,15 However, modifiable factors such as medications used to facilitate EETI, intravascular volume resuscitation prior to EETI, technical laryngoscopy skills, and aggressive positive pressure ventilation may cause or exacerbate PIHI. 11 Therefore, it is possible that EETI may contribute to poor patient outcomes due to hemodynamic instability resulting from the intubation procedure. 16 Recent studies have demonstrated the high rate of PIHI (23-44%) and an association of PIHI with increased hospital length of stay (increased 3.8 days) and mortality (increased 12%).…”

Section: Ré Sumémentioning

confidence: 99%

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Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Green

Hutton

Lorette

et al. 2014

CJEM

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Objective: Hemodynamic instability following emergent endotracheal intubation (EETI) is a potentially life-threatening adverse event. The objectives of this systematic literature review were to document the incidence of postintubation hemodynamic instability (PIHI), to determine the definitions for PIHI used in the available literature, and to examine factors associated with PIHI in adult patients who require EETI. Data Source: Articles published in Medline (1966-August 2012. Study Selection: This systematic review included adult, inhospital studies of EETIs. Studies with nonemergent or pediatric patient populations were excluded. Data Extraction: Two authors independently performed data abstraction. Disagreements were resolved by a third party. The methodological quality of included studies was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. Data Synthesis: We estimated the pooled prevalence of PIHI across studies using a random effects meta-analysis. Subgroups analyzed included study design, intubation setting, geographic location of the study, physician experience, medications used for sedation, neuromuscular blockade, and definition of PIHI. Eighteen studies were analyzed, with sample sizes from 84 to 2,833 patients. The incidence of PIHI ranged from 5 to 440 cases per 1,000 intubations, with a pooled estimate of 110 cases per 1,000 intubations (95% CI 65-167). Conclusions: PIHI was found to occur in 110 cases per 1,000 in-hospital, emergent intubations. However, heterogeneity among the included studies limits the reliability of this summary estimate. Further investigation is warranted. RÉ SUMÉObjectifs: L'instabilité hé modynamique consé cutive à une intubation endotraché ale trè s urgente (IETU) est un é vé nement indé sirable potentiellement mortel. L'examen mé thodique de la documentation avait pour objectifs d'é tablir la fré quence de l'instabilité hé modynamique aprè s intubation (IHAI), de dé terminer les dé finitions de l'IHAI utilisé es dans la documentation et d'examiner les facteurs associé s à l'IHAI chez les adultes. Source de donné es: Les articles publié s dans Medline (1966-aoû t 2012) ont constitué la source de donné es. Sé lection des é tudes: L'examen mé thodique portait sur les é tudes ayant pour objet les IETU effectué es chez les adultes, en milieu hospitalier; les é tudes portant sur les intubations non considé ré es comme trè s urgentes ou effectué es chez les enfants é taient é carté es. Extraction des donné es: Deux auteurs ont procé dé , chacun de leur cô té , aux ré sumé s analytiques des donné es. Les divergences de point de vue ont é té ré solues par une tierce partie. La qualité mé thodologique des é tudes retenues a é té é valué e selon l'é chelle de NewcastleOttawa, qui permet d'é valuer la qualité des é tudes de cohortes. Synthè se des donné es: L'estimation de la pré valence globale de l'IHAI, tiré e des é tudes retenues repose sur une mé taanalyse à effets alé atoires. Ont é té analysé s le type d'é tude, le service où ont é té eff...

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Section: Discussionmentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

Section: Ré Sumémentioning

confidence: 99%

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Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Green

Hutton

Lorette

et al. 2014

CJEM

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“…A: adjust, attention Hypotension is common following induction of anesthesia and is increasingly associated with morbidity and mortality. 5,43 It results from both pharmacologically associated sympatholysis and the conversion from negative-pressure to positive-pressure ventilation. Thus, team leaders should expect to adjust anesthetic induction doses and approaches, including pretreatment with lower doses of propofol, benzodiazepines, and opiates, each of which reduces the sympathetic drive.…”

Section: P: Plans a And Bmentioning

confidence: 99%

“…[1][2][3][4][5][6] The Oxford Dictionary defines ''ectopic'' as ''an abnormal place or position'', which for anesthesiologists is outside the OR. As a result, airway management outside the operating room could also be known as ''ectopic'', ''satellite'', or ''remote'' airway management.…”

Section: Introductionmentioning

confidence: 99%

Airway management outside the operating room: how to better prepare

Brindley

Beed

Law

et al. 2017

Can J Anesth/J Can Anesth

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Airway management outside the operating room is associated with increased risks compared with airway management inside the operating room. Moreover, airway management-whether in the intensive care unit, emergency department, interventional radiology suite, or general wards-often requires mastery of not only the anatomically difficult airway but also the physiologically and situationally difficult airway. The 2015 Difficult Airway Society Guidelines encourage the airway team to ''stop and think''. This article provides a practical review of how that evidence applies during emergency airway management outside of the operating room. To counter the challenges of airway management outside the operating room, we offer a mnemonic that combines both technical and non-technical insights summarized using the seven letters of the word PREPARE (P: pre-oxygenate/position; R: reset/resist; E: examine/explicit; P: plan A/B; A: adjust/ attention; R: remain/review; E: exit/explore). We hope it can unite potentially disparate personnel with a structure that allows them to make acute decisions, coordinate action, and communicate unequivocally. This multidisciplinary publication also hopes to encourage common understanding and language between anesthesiologists and non-anesthesiologists about the perils of airway management outside the operating room and the importance of airway teamwork.Résumé La gestion des voies aériennes en dehors de la salle d'opération est associée à une augmentation des risques, comparativement à leur gestion à l'intérieur de la salle d'opération. De plus, la gestion des voies aériennes -que ce soit en unité de soins intensifs, aux urgences, dans une unité de radiologie interventionnelle ou dans un service général -nécessite souvent une maîtrise face, tout d'abord, aux voies aériennes compliquées sur le plan anatomique, mais aussi face aux voies aériennes difficiles à gérer sur le plan physiologique et en situation. Les lignes directrices 2015 de la DAS (Difficult Airway Society) encouragent l'équipe de prise en charge des voies aériennes à « faire une pause et réfléchir ». Cet article fournit une synthèse pratique de l'application des données probantes au cours de la gestion des voies aériennes en urgence, en dehors de la salle d'opération. Pour faire face aux défis de la gestion des voies aériennes en dehors de la salle d'opération, nous proposons un moyen mnémotechnique qui combine des points techniques et non techniques, résumés dans les sept lettres du mot PRÉ PARE (P : préoxygéner/position; R : reprendre/ résister; E : examiner/expliquer; P : plan A/plan B; A : adapter/attention; R : rester/revoir; E : explorer/quitter). Nous espérons que cela peut rassembler des personnels potentiellement disparates dans une structure qui leur permette de prendre des décisions, coordonner leurs

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Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis

Cherfan¹,

Arabi

Al‐Dorzi³

et al. 2012

Pharmacotherapy

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Etomidate is a potent imidazole hypnotic used widely in single doses in the rapid sequence intubation of critically ill patients with sepsis due to its presumed hemodynamic safety, fast onset, and short duration of action. However, the literature is conflicting regarding the hemodynamic advantages of etomidate over other induction agents, and its safety in this population is a matter of strong debate in the critical care community as the drug is associated with suppression of adrenal steroidogenesis, which can last up to 72 hours after a single dose, primarily through potent inhibition of the 11β-hydroxylase enzyme. However, the clinical impact of this adrenal suppressive effect is not certain. The use of continuous-infusion etomidate in critically ill patients was abandoned more than 20 years ago due to reports of increased mortality. Nevertheless, mortality data of single-dose etomidate are still controversial, with no strong evidence of benefit over other agents and a tendency toward harm (keeping in mind the limitations of the available literature). Proponents of single-dose etomidate use in patients with sepsis suggest that the increased mortality associated with etomidate is merely a reflection of the patients' severity of illness and not related to the drug itself, whereas others believe that the drug causes true harm and increases mortality in this population. In view of the lack of a clear clinical advantage of etomidate over other agents used in rapid sequence intubation, it would be prudent to favor other agents until further conclusive evidence of etomidate safety is available in critically ill patients with sepsis.

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Complications of Emergency Tracheal Intubation: Hemodynamic Alterations - Part I

Cited by 134 publications

References 77 publications

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Airway management outside the operating room: how to better prepare

Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis

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