Adverse Effects of Intratracheal Intubation by Emergency Medicine Residents; a Cross-Sectional Study
Iranian Journal of Emergency Medicine,
Vol. 4 No. 2 (2017),
30 March 2017
,
Page 56-52
https://doi.org/10.22037/ijem.v4i2.14658
Abstract
Introduction: Airway management of patients is among the responsibilities of an emergency medicine specialist. To decrease the adverse effects of intubation, sufficient knowledge of the drugs used and proper skill in intratracheal intubation is needed. Therefore, the present study was carried out aiming to evaluate the success rate and adverse effects of intratracheal intubation by emergency medicine residents. Methods: This cross-sectional study was done during 18 months in the emergency department (ED) of Imam Hossein Hospital, Tehran, Iran. All the residents who had spent at least 6 months of their education program in ED and had passed the 2-month specialized course in anesthesiology rotation were included in the study using census method. The researcher, who was a senior emergency medicine resident, would be present at the time of intubation and would gather the required data using a pre-designed checklist. Hypoxia, hypotension, aspiration, esophageal intubation, right main bronchus intubation, fracture of teeth, and tracheal rupture were considered as the studied adverse effects. In addition, more than 3 attempts for intratracheal intubation was considered unsuccessful intubation. Results: Finally, the findings of 100 patients with the mean age of 63.4 ± 16.8 years were analyzed (57% female). Attempts for intratracheal intubation were successful in all cases and 81 patients were intubated on first attempt, 15 on second attempt and 4 on third attempt. There was no unsuccessful intubation that needed more than 3 attempts among the residents. Success rate of intubation was 31 (83%) cases among first year residents, 52 (94%) cases in second year residents and 17 (100%) cases for third year residents. This difference among residents in various levels was statistically significant (p = 0.0014). Hypoxia, esophageal intubation, aspiration, hypotension, and right main bronchus intubation, were the most common adverse effects observed, respectively. No fracture of teeth or tracheal rupture case was observed. Rates of esophageal intubation (p = 0.002) and right main bronchus intubation (p = 0.023) were significantly different among residents of different levels. Number of attempts and adverse effects of intratracheal intubation were significantly related in this study as 75 (88%) cases of the observed adverse effects were seen in those who were intubated on the first attempt. Meanwhile, adverse effects were seen in only 6 (7%) cases that were intubated on the second or third attempt (p < 0.001). Conclusion: Attempts for intratracheal intubation was successful in all the patients but the difference in number of attempts was statistically significant between the residents of various levels. Hypoxia, esophageal intubation, aspiration, hypotension, and right main bronchus intubation, were the most common adverse effects observed, respectively. No fracture of teeth or tracheal rupture case was observed.- طب اورژانس؛ اداره راه هوایی؛ لوله گذاری داخل تراشه؛ دوره دستیاری و کارورزی؛ عوارض جانبی
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References
Tayal VS, Riggs RW, Marx JA, Tomaszewski CA, Schneider RE. Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period. Academic emergency medicine. 1999;6(1):31-7.
Sinclair RC, Luxton MC. Rapid sequence induction. Continuing Education in Anaesthesia, Critical Care & Pain. 2005;5(2):45-8.
Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C. Complications of emergency intubation with and without paralysis. The American journal of emergency medicine. 1999;17(2):141-3.
Shojaee M, Kariman H, Hatamabadi HR, Sabzghabaie A, Dolatabadi AA, Moghadam MA, et al. History and Guideline of Emergency Medicine Residency Discipline in Shahid Beheshti University of Medical Sciences, Iran; Review of 2014. Iranian Journal of Emergency Medicine. 2014;1(1):2-10.
Sloane C, Vilke GM, Chan TC, Hayden SR, Hoyt DB, Rosen P. Rapid sequence intubation in the field versus hospital in trauma patients. The Journal of emergency medicine. 2000;19(3):259-64.
Sagarin MJ, Chiang V, Sakles JC, Barton ED, Wolfe RE, Vissers RJ, et al. Rapid sequence intubation for pediatric emergency airway management. Pediatric emergency care. 2002;18(6):417-23.
Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive care medicine. 2010;36(2):248-55.
Schmidt UH, Kumwilaisak K, Bittner E, George E, Hess D. Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation. The Journal of the American Society of Anesthesiologists. 2008;109(6):973-7.
Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesthesia & Analgesia. 2004;99(2):607-13.
Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive care medicine. 2008;34(10):1835-42.
Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3,423 Emergency Tracheal Intubations at a University HospitalAirway Outcomes and Complications. The Journal of the American Society of Anesthesiologists. 2011;114(1):42-8.
Simpson G, Ross M, McKeown D, Ray D. Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. British journal of anaesthesia. 2012;108:792-9.
Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84(11):1500-4.
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