Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries

Russotto, Vincenzo; Myatra, Sheila Nainan; Laffey, John G.; Tassistro, Elena; Antolini, Laura; Bauer, Philippe R.; Lascarrou, Jean Baptiste; Szułdrzyński, Konstanty; Camporota, Luigi; Pelosi, Paolo; Sorbello, Massimiliano; Higgs, A.; Greif, Robert; Putensen, Christian; Agvald-Öhman, Christina; Chalkias, Athanasios; Bokums, Kristaps; Brewster, David; Rossi, Emanuela; Fumagalli, Roberto; Artigas, Antonio; Foti, Giuseppe; Bellani, Giacomo; investigators, Intube Study

doi:10.1001/jama.2021.1727

Cited by 255 publications

(176 citation statements)

References 22 publications

(45 reference statements)

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“…Complications related to tracheal intubation are higher in ICU than in operating room [ 4 , 5 ] because of anatomical difficulty, physiological difficulty such as pre-existing hypoxia and haemodynamic instability and logistical difficulty. First-attempt intubation success [ 6 , 7 ] is associated with reduced likelihood of complications related to tracheal intubation [ 1 , 6 ] and reduce the time needed for intubation, thus reducing exposure time of the healthcare worker to potential pathogens.…”

Section: Introductionmentioning

confidence: 99%

Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients

Jaber¹,

Rolle²,

Godet³

et al. 2021

Intensive Care Med

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The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone. Methods:In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.Results: A total of 999 patients were included in the modified intention-to-treat analysis: 501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%

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Section: Introductionmentioning

confidence: 99%

Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients

Jaber¹,

Rolle²,

Godet³

et al. 2021

Intensive Care Med

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“…Midazolam may modulate the immune system by binding to the peripheral receptor of macrophages and inhibiting the proinflammatory responses [ 21 ], while ketamine acts at different levels of inflammation, interacting with inflammatory cell recruitment, cytokine production (IL-6, TNF- α ), and regulation of inflammatory mediators [ 12 ], which could explain in-part the nonsignificant increase in white blood cells. Also, propofol exerts inhibitory effects on neutrophil and monocyte function under different physiological and pathological circumstances, while the effects of cisatracurium and fentanyl are diverse in different disease states and must be further studied [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Baseline Values and Kinetics of IL-6, Procalcitonin, and TNF-α in Landrace-Large White Swine Anesthetized with Propofol-Based Total Intravenous Anesthesia

Chalkias

Spyropoulos

Γεωργίου

et al. 2021

BioMed Research International

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The baseline levels of various inflammatory mediators and their changes during anesthesia in swine are not known. The aim of this animal study was to measure the baseline values and kinetics of interleukin-6, procalcitonin, and tumor necrosis factor-alpha in healthy Landrace-Large White swine anesthetized with propofol-based total intravenous anesthesia. We included 8 healthy male pigs with an average weight of 19 ± 2 kg (aged 10-15 weeks) that were subjected to propofol-based total intravenous anesthesia for 8 hours. Complete blood count, serum chemistry, and serum levels of interleukin-6, procalcitonin, and tumor necrosis factor-alpha were analyzed, and serum levels were quantified hourly. Blood was also collected for bacterial culturing. Baseline values of interleukin-6 and procalcitonin were 18 pg/ml and 21 ng/ml, respectively, while tumor necrosis factor-alpha was not detectable during collection of baseline samples. A statistically significant difference was observed in interleukin-6 levels between time points ( p < 0.0001 ). Procalcitonin increased with time, but there were no significant differences between time points ( p = 0.152 ). Tumor necrosis factor-alpha increased until the 3rd hour of propofol-based total intravenous anesthesia, while after the 4th hour, it gradually decreased, reaching its baseline undetectable values by the 7th hour ( p < 0.001 ). Our results can serve as the basis for further translational research.

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“…First attempt intubation success is important as multiple attempts are known to increase both major complications and mortality. A recent large muti-centered study demonstrated a signi cant increase in ICU mortality after just one attempt failure in the critically ill. 20 In subgroup analysis of combined techniques, use of a TCI™ as a dynamic stylet had a higher rate of rst pass success than when a FOB was used as a dynamic stylet. This is interesting as both TCI™ and FOB possess exible shafts and articulating tips which are important for dynamic tracheal access.…”

Section: First Attempt Intubation Successmentioning

confidence: 99%

Are Combined Techniques Using Video Laryngoscopes and Dynamic Stylets Superior to Fiberoptic Techniques for Anticipated Difficult Intubations? A Retrospective Case Control Study

Shah

Knecht

Jacobson

et al. 2021

Preprint

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Difficult intubations can require advanced intubation techniques. Studies point to potential advantages of combined techniques using video laryngoscopes (VL) and dynamic stylets for anticipated difficult intubations. This study is designed to compare combined techniques to awake and asleep fiberoptic (FOB) techniques.Methods: 138,387 consecutive anaesthesia cases were reviewed for use of: FOB awake, FOB asleep, or combined technique (VL for visualization and either a FOB or a novel TCITM articulating introducer ((TCITM; Through The Cords, LLC; Salt Lake City, UT)) as dynamic stylets as a primary approach for anticipated difficult intubations. Primary end points measured: first attempt success rate, failure to intubate with the primary technique, “in-room to intubation’ time, reported traumatic intubation rate, and reported ease of intubation.Results: Significant differences were found between techniques. First pass success rate was highest in combined techniques (either VL + FOB or VL + TCITM) (88.7%) followed by FOB awake (74.2%, P<0.001) and FOB asleep (80.7%, P=0.06). “Failure to intubate with the primary technique” was lowest in combined techniques (1.8%) followed by FOB asleep (4.6%, P=0.11) and FOB awake (9.2%, P=0.002). “In room to intubated” time was fastest in combined techniques (13.0 minutes) followed by FOB asleep (15.1 minutes, P=0.002) and FOB awake (21.2 minutes, P<0.001). Combined techniques were rated as ‘easy’ more often (72%) followed by FOB asleep (62.9%, P=0.12) and FOB awake (38.2%, P<0.001). Combined techniques were rated as “atraumatic” more often (91.1%) followed by FOB asleep (89.4%, P=0.91) and FOB awake (75.8%, P<0.001). In subgroup analysis of combined techniques, VL + TCITM had the highest first attempt success rate (90.2%), lowest failure rate (1%, P=0.56), and shortest “in room to intubated time” (12.1 minutes, P=0.12). It was also rated as "easy” (83.3%, P<0.001), and “atraumatic“ (96.1%, P=0.009) more often than VL + FOB, FOB awake or FOB asleep.Conclusions: Combined techniques outperformed FOB techniques in terms of effectiveness, speed, ease of use, and patient injury in patients with risk factors for difficult intubation. As a sub-group of combined technique, VL + TCITM outperformed all other techniques. Combined techniques should be considered when managing difficult intubations.

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Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries

Cited by 255 publications

References 22 publications

Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients

Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients

Baseline Values and Kinetics of IL-6, Procalcitonin, and TNF-α in Landrace-Large White Swine Anesthetized with Propofol-Based Total Intravenous Anesthesia

Are Combined Techniques Using Video Laryngoscopes and Dynamic Stylets Superior to Fiberoptic Techniques for Anticipated Difficult Intubations? A Retrospective Case Control Study

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