Predictive value of difficult airway identifiers for intubation‐related complications in the emergency department

Abstract

Objectives: The Airway Alert banner at our institution alerts physicians to patients with the potential for a difficult intubation. Difficult airway guidelines can reduce intubation complications in the operating room, but little research has been done in the emergency department (ED). We hypothesize that patients meeting criteria for the banner will have a more difficult intubation and increased complications.Methods: Patients greater than 18 years old who presented to the ED for any complaint and required intubation were reviewed from January 2015 to January 2020 and divided into those meeting criteria for a difficult airway ("criteria cohort") and those who did not ("non-criteria cohort"). Past medical history and details of the intubation were collected. Results:The mean number of attempts for intubation was 1.60 in the criteria cohort and 1.36 in the non-criteria cohort (P > .05). The mean grade of view was 1.73 and 1.39, respectively (P < .05). The average size of endotracheal tube was 7.50 and 7.74 in the criteria and non-criteria cohorts (P < .05). The use of adjuncts was 28.6% and 12.5%, respectively (P < .01). The average number of intubation attempts and complication rate did not differ significantly.Conclusions: Intubations in patients meeting criteria for the banner are associated with a more difficult view, use of smaller endotracheal tube, and increased use of adjuncts, but not with a significantly higher rate of complications or attempts. Physicians should prepare with additional endotracheal tube sizes, adjuncts, and a plan for secondary strategies in these patients.

Enfermedades crónicas no transmisibles como factor de riesgo para una vía aérea difícil

“…Los médicos deben prepararse con tamaños adicionales de tubos endotraqueales, complementos y un plan para estrategias secundarias en estos pacientes. 16 El introductor del tubo traqueal, conocido como bougie, generalmente se usa para ayudar en la intubación traqueal en vistas laringoscópicas deficientes o después de que fallan Edison Fernando Zambrano-Macias; Johanna Elizabeth Alcívar Alcívar 89 los intentos de intubación. No está claro el efecto del uso rutinario de bujías en el éxito de la intubación en el primer intento.…”