An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study

• Published in: Intensive care medicine Vol. 36; no. 2; pp. 248 - 255
• Main Authors: Jaber, Samir, Jung, Boris, Corne, Philippe, Sebbane, Mustapha, Muller, Laurent, Chanques, Gerald, Verzilli, Daniel, Jonquet, Olivier, Eledjam, Jean-Jacques, Lefrant, Jean-Yves
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-02-2010; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Acute respiratory distress syndrome; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Critical Care Medicine; Emergency Medicine; Evidence-based medicine; Female; Hospital patients; Human health and pathology; Humans; Intensive; Intensive care medicine; Intensive Care Units - statistics & numerical data; Intubation, Intratracheal - statistics & numerical data; Life Sciences; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Positive-Pressure Respiration; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Practice Guidelines as Topic; Prospective Studies; Quality control; Quality management; Respiration, Artificial - statistics & numerical data; Succinylcholine; France; Practice guidelines; Airway management; Intubation; Complications; Non-invasive ventilation; Mechanical ventilation; Intensive care; Clinical management; Complication; Resuscitation; Intensive care unit
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-009-1717-8

Objective
To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit (ICU).
Design
Two-phase, prospective, multicenter controlled study.
Setting
Three medical-surgical ICUs in two university hospitals.
Patients
Two hundred three consecutive ICU patients required 244 intubations.
Interventions
All intubations performed during two consecutive phases (a 6-month quality control phase followed by a 6-month intervention phase based on the implementation of an ICU intubation bundle management protocol) were evaluated. The ten bundle components were: preoxygenation with noninvasive positive pressure ventilation, presence of two operators, rapid sequence induction, cricoid pressure, capnography, protective ventilation, fluid loading, preparation and early administration of sedation and vasopressor use if needed.
Measurements and main results
The primary end points were the incidence of life-threatening complications occurring within 60 min after intubation (cardiac arrest or death, severe cardiovascular collapse and hypoxemia). Other complications (mild to moderate) were also evaluated. Baseline characteristics, including demographic data and reason for intubation (mainly acute respiratory failure), were similar in the two phases. The intubation procedure in the intervention phase (
n
 = 121) was associated with significant decreases in both life-threatening complications (21 vs. 34%,
p
 = 0.03) and other complications (9 vs. 21%,
p
 = 0.01) compared to the control phase (
n
 = 123).
Conclusions
The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients.