Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?

Abstract

Number of tables: 6 2 AbstractPurpose Airway management in severe bronchial asthma exacerbation (BAE) carries very high risk and should be performed by experienced providers. However, no objective data are available on the association between the laryngoscopist's specialty and endotracheal intubation (ETI)-related adverse events in patients with severe bronchial asthma. In this paper, we compare emergency ETI-related adverse events in patients with severe BAE between anesthesiologists and other specialists.Methods This historical cohort study was conducted at a Japanese teaching hospital. We analyzed all BAE patients who underwent ETI in our emergency department from January 2002 to January 2014.Primary exposure was the specialty of the first laryngoscopist (anesthesiologist vs. other specialist).The primary outcome measure was the occurrence of an ETI-related adverse event, including severe bronchospasm after laryngoscopy, hypoxemia, regurgitation, unrecognized esophageal intubation, and ventricular tachycardia. Conclusion Anesthesiologist as first exposure was independently associated with attenuated risk of 3 ETI-related adverse events in patients with severe BAE. The skill and knowledge of anesthesiologists should be applied to high-risk airway management whenever possible. Results

Association between off-hour presentation and endotracheal-intubation-related adverse events in trauma patients with a predicted difficult airway: A historical cohort study at a community emergency department in Japan

“…Hypoxemia was defined as a decline in pulse oximetry saturation > 10 % from baseline during ETI attempts, not as a result of esophageal intubation [30]. Esophageal intubation with delayed recognition was defined as misplacement of the endotracheal tube in the upper esophagus or hypopharynx, with time elapsed and desaturation (>10 % decline in saturation on pulse oximetry) [30–32].…”

“…Hypoxemia was defined as a decline in pulse oximetry saturation > 10 % from baseline during ETI attempts, not as a result of esophageal intubation [30]. Esophageal intubation with delayed recognition was defined as misplacement of the endotracheal tube in the upper esophagus or hypopharynx, with time elapsed and desaturation (>10 % decline in saturation on pulse oximetry) [30–32]. Recorded regurgitation was defined as the immediate peri-induction of gastric contents at the glottis opening or in the endotracheal tube, clearly documented in the ED or in the nursing records [30–32].…”

“…Esophageal intubation with delayed recognition was defined as misplacement of the endotracheal tube in the upper esophagus or hypopharynx, with time elapsed and desaturation (>10 % decline in saturation on pulse oximetry) [30–32]. Recorded regurgitation was defined as the immediate peri-induction of gastric contents at the glottis opening or in the endotracheal tube, clearly documented in the ED or in the nursing records [30–32]. Cardiac arrest immediately after ETI attempt included asystole, bradycardia, or dysrhythmia without measurable blood pressure and requiring cardiopulmonary resuscitation during or immediately after the ETI attempt [31, 32].…”

“…Mainstem bronchus intubation was determined on a chest X-ray or computed tomography scan taken immediately after the ETI procedure. Some previous studies have included hemodynamic parameters, such as hypertension and hypotension in their definition of ETI-related complications [11, 13–15, 30–32]. However, for consistency with the more recent literature [12, 33], we chose not to include hemodynamic data because it is difficult to distinguish ETI-related hemodynamic perturbations from underlying trauma-based etiologies.…”

“…A set of potential confounders was chosen based on previous information (operator with anesthesiology background [15, 30, 34, 35], anatomical severity [20, 21], and use of paralytic agent [36–39]).…”