Prospective observational study of the practice of endotracheal intubation in the emergency department of a tertiary hospital in Sydney, Australia

Abstract

Although the majority of results are comparable with overseas data, the rates of difficult laryngoscopy and desaturation are higher than previously reported. We feel that this data has highlighted the need for practice improvement within our department and we would encourage all those who undertake emergent airway management to audit their own practice of this high-risk procedure.

Postintubation hypotension in intensive care unit patients: A multicenter cohort study

“…intubation, mainstem bronchus intubation, bronchospasm, and aspiration of gastric contents into the respiratory system) and broader life-threatening complications (hypotension, arrhythmia, and cardiac arrest) [6][7][8][9][10][11][12][13][14][25][26][27][30][31][32][33][34][35][36]. In patients requiring ETI, the AEs most commonly reported include tube misplacement or dislodgement, multiple ETI attempts, and failed ETI efforts [17,18,37].…”

“…However, the need for ETI presents a physiologic challenge to an often unstable patient population that may poorly tolerate this procedure [4,5]. Compared to elective intubations, ETI in critically ill patients is associated with increased frequency of adverse events (AEs) including aspiration, bradycardia, intubation difficulty, hypoxemia, pneumothorax, and cardiac arrest [6][7][8][9][10][11][12][13][14]. The etiology of AEs is likely multi-factorial including: patient illness; ETI medications; airway manipulation, and the physiologic derangements that follow positive pressure ventilation (PPV) [15][16][17][18].…”

Apneic Oxygenation Was Associated With Decreased Desaturation Rates During Rapid Sequence Intubation by an Australian Helicopter Emergency Medicine Service

“…This definition cutoff is higher than that of some published literature from the United Kingdom and Europe, which defines desaturation as SpO 2 below 90%, but is a standard used in Australian studies. [5][6][7]10 In our service, an SpO 2 of 93% is used because this is the value beyond which the steep section of oxygen dissociation curve begins and further desaturation occurs more rapidly. This conservative definition is consistent with that used in the Australian Emergency Airway Registry.…”

“…This conservative definition is consistent with that used in the Australian Emergency Airway Registry. 10 Volume 65, no. 4 : April 2015…”

BET 2: Should real resuscitationists use airway checklists?

“…Adverse events are common and can precipitate underlying injury, delay effective care and occasionally result in catastrophic patient outcome (Cook et al 2011, Fogg et al 2012) 5 6…”