Early Intubation in the Management of Trauma Patients: Indications and Outcomes in 1,000 Consecutive Patients

Sise, Michael J.; Shackford, Steven R.; Sise, C. Beth; Sack, Daniel I.; Paci, Gabrielle M.; Yale, Randy S.; O’Reilly, Eamon B.; Norton, Valerie C.; Huebner, Benjamin R.; Peck, Kimberly A.

doi:10.1097/ta.0b013e318191bb0c

Cited by 62 publications

(49 citation statements)

References 15 publications

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“…16 The findings from this study provide the strongest support yet for this recommendation with respect to airway management, suggesting that conservative management of gamma-hydroxybutyrate-related cases in the ED is associated with shorter ED length of stay and may also be associated with decreased odds of admission to hospital. Given the risks associated with intubation, 17 our study suggests that routine intubation of uncomplicated gamma-hydroxybutyrate-related cases according to Glasgow Coma Scalederived criteria (e.g., score 8 or less) is unwarranted. This is especially important in the context of changes in ED practice resulting from policy changes such as the National Emergency and Access Target in Australia: the increased ED length of stay may lead to unnecessary admission if the stay exceeds 4 hours without any additional safety benefits for patients.…”

Section: Discussionmentioning

confidence: 99%

“…In this study we examined whether intubation (an invasive, time-consuming, labor-intensive procedure that, even when implemented by the experienced operator, may be associated with increased morbidity to the patient 17 ) is associated with decreased ED length of stay (LOS), as reducing time spent in EDs is a key policy target. 18 Whether patients were further admitted to hospital was considered as a secondary outcome.…”

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confidence: 99%

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Effect of Intubation for Gamma‐hydroxybutyric Acid Overdose on Emergency Department Length of Stay and Hospital Admission

Dietze

Horyniak

Agius

et al. 2014

Academic Emergency Medicine

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Objectives: The objective was to examine the effect of endotracheal intubation on emergency department (ED) length of stay (LOS) and admission rates for patients with gamma-hydroxybutyrate (GHB) overdose.Methods: A 3-year retrospective electronic and paper audit of recreational drug presentations was carried out at two major inner-city EDs in Melbourne, Australia. Different GHB overdose management strategies exist at the respective audit sites, namely: 1) all patients with a Glasgow Coma Scale (GCS) score of 8 or less are intubated or 2) uncomplicated patients with GCS scores of 8 or less are managed without intubation (conservative management), unless further complications arise. This difference allows for comparison of the effects of intubation. All suspected GHB-related cases (defined as cases where GHB or its analogs gamma-butyrolactone or 1,4-butanediol were recorded) in which altered consciousness state was noted as a presenting symptom at triage were selected from all recreational drug-related presentations occurring between January 2008 and December 2010. The relationship between intubation and the primary outcome, ED LOS, was examined using robust regression after adjustment for potential confounders. The relationship between intubation and admission status (admission to hospital versus discharge) was also examined using logistic regression.Results: After adjustment for potential confounders such as GCS score, intubation of GHB-related cases in the ED was associated with an increase in mean LOS of 41% (95% confidence interval [CI] = 19% to 65%) and an increase in the odds of admission to hospital of 9.95 (95% CI = 2.36 to 41.88) at one hospital site, compared to conservative airway management.Conclusions: Conservative airway management (no intubation) is associated with shorter ED LOS in cases of uncomplicated GHB-related coma in the ED and may also be associated with lower admission rates for these patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Intubation for Gamma‐hydroxybutyric Acid Overdose on Emergency Department Length of Stay and Hospital Admission

Dietze

Horyniak

Agius

et al. 2014

Academic Emergency Medicine

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“…10,12 The decision to perform an awake intubation technique without neuromuscular blockade should be chosen with the following criteria in mind: a difficult airway patient who is cooperative, stable, and spontaneously breathing. 2,13,9,7 Obviously, our patient satisfied this criteria.…”

Section: Discussionmentioning

confidence: 99%

Airway management of penetrating neck injury by large foreign body impalement: Report of a case

et al. 2010

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“…Die Inzidenz der Etablierung eines chirurgischen Atemwegs ist bei der Atemwegssicherung durch Anäs-thesien im innerklinischen Bereich mit < 1% sehr selten [86]. Die Anwesenheit eines anästhesiologischen Oberarztes ist im Rahmen von innerklinischen Notfallintubationen mit signifikant weniger Komplikationen assoziiert [82].…”

Section: Supervision Im Innerklinischen Bereichunclassified

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

et al. 2011

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Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). With the availability of ketamine as a viable alternative, the use of etomidate is not encouraged due to its side effects on adrenal function. An electrocardiogram (ECG), blood pressure measurement and pulse oximetry are needed to monitor the emergency anesthesia and the secured airway. Capnography is absolutely mandatory to confirm correct placement of the endotracheal tube and to monitor tube dislocations as well as ventilation and oxygenation in the prehospital and hospital setting. Because airway management is often complicated in trauma patients, alternative devices and a fiber-optic endoscope need to be available within the hospital. Use of these alternative measures for airway management and ventilation should be considered at the latest after a maximum of three unsuccessful intubation attempts. Emergency medical service (EMS) physicians should to be trained in emergency anesthesia, ETI and alternative methods of airway management on a regular basis. Within hospitals ETI, emergency anesthesia and ventilation are to be conducted by trained and experienced anesthesiologists. When a difficult airway or induction of anesthesia is expected, endotracheal intubation should be supervised or conducted by an anesthesiologist. Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.

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Early Intubation in the Management of Trauma Patients: Indications and Outcomes in 1,000 Consecutive Patients

Cited by 62 publications

References 15 publications

Effect of Intubation for Gamma‐hydroxybutyric Acid Overdose on Emergency Department Length of Stay and Hospital Admission

Effect of Intubation for Gamma‐hydroxybutyric Acid Overdose on Emergency Department Length of Stay and Hospital Admission

Airway management of penetrating neck injury by large foreign body impalement: Report of a case

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

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