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Reintubation in critically ill patients: Procedural complications and implications for care

Elmer, J and Lee, S and Rittenberger, JC and Dargin, J and Winger, D and Emlet, L (2015) Reintubation in critically ill patients: Procedural complications and implications for care. Critical Care, 19 (1). ISSN 1364-8535

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Abstract

© 2015 Elmer et al. Introduction: In critically ill patients, re-intubation is common and may be a high-risk procedure. Anticipating a difficult airway and identifying high-risk patients can allow time for life-saving preparation. Unfortunately, prospective studies have not compared the difficulty or complication rates associated with reintubation in this population. Methods: We performed a secondary analysis of a prospective registry of in-hospital emergency airway management, focusing on patients that underwent multiple out-of-operating room intubations during a single hospitalization. Our main outcomes of interest were technical difficulty of intubation (number of attempts, need for adjuncts to direct laryngoscopy, best Cormack-Lehane grade and training level of final intubator) and the frequency of procedural complications (aspiration, arrhythmia, airway trauma, new hypotension, new hypoxia, esophageal intubation and cardiac arrest). We compared the cohort of reintubated patients to a matched cohort of singly intubated patients and compared each repeatedly intubated patient's first and last intubation. Results: Our registry included 1053 patients, of which 151 patients (14%) were repeatedly intubated (median two per patient). Complications were significantly more common during last intubation compared to first (13% versus 5%, P = 0.02). The most common complications were hypotension (41%) and hypoxia (35%). These occurred despite no difference in any measure of technical difficultly across intubations. Conclusion: In this cohort of reintubated patients, clinically important procedural complications were significantly more common on last intubation compared to first.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Elmer, J
Lee, S
Rittenberger, JCjcrst19@pitt.eduJCRST19
Dargin, J
Winger, Ddgw14@pitt.eduDGW14
Emlet, Llle4@pitt.eduLLE4
Date: 16 January 2015
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 19
Number: 1
DOI or Unique Handle: 10.1186/s13054-014-0730-7
Schools and Programs: School of Medicine > Critical Care Medicine
School of Medicine > Emergency Medicine
Refereed: Yes
ISSN: 1364-8535
Date Deposited: 22 Dec 2016 15:25
Last Modified: 13 Oct 2017 23:55
URI: http://d-scholarship.pitt.edu/id/eprint/29424

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