Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit : A Prospective, Observational Study
Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room.
METHODS: The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications.
RESULTS: A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV: 116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV: 159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001).
CONCLUSIONS: Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications.
| Errataetall: |
CommentIn: Anesthesiology. 2019 Jun;130(6):1089-1090. - PMID 31090620 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:129 |
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| Enthalten in: |
Anesthesiology - 129(2018), 2 vom: 19. Aug., Seite 321-328 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Taboada, Manuel [VerfasserIn] |
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| Links: |
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| Themen: |
Comparative Study |
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| Anmerkungen: |
Date Completed 09.01.2019 Date Revised 09.01.2019 published: Print CommentIn: Anesthesiology. 2019 Jun;130(6):1089-1090. - PMID 31090620 Citation Status MEDLINE |
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| doi: |
10.1097/ALN.0000000000002269 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM284332348 |
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| 500 | |a CommentIn: Anesthesiology. 2019 Jun;130(6):1089-1090. - PMID 31090620 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room | ||
| 520 | |a METHODS: The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications | ||
| 520 | |a RESULTS: A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV: 116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV: 159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001) | ||
| 520 | |a CONCLUSIONS: Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Doldan, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Calvo, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Almeida, Xavier |e verfasserin |4 aut | |
| 700 | 1 | |a Ferreiroa, Esteban |e verfasserin |4 aut | |
| 700 | 1 | |a Baluja, Aurora |e verfasserin |4 aut | |
| 700 | 1 | |a Cariñena, Agustin |e verfasserin |4 aut | |
| 700 | 1 | |a Otero, Paula |e verfasserin |4 aut | |
| 700 | 1 | |a Caruezo, Valentin |e verfasserin |4 aut | |
| 700 | 1 | |a Naveira, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Otero, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Alvarez, Julian |e verfasserin |4 aut | |
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