Urgent tracheal intubation in general hospital units: an observational study.

STUDY OBJECTIVE To determine the frequency of complications and outcomes of urgent intubations in general hospital units. DESIGN Prospective, observational, cohort study. SETTING University-affiliated hospital. PATIENTS 150 patients who underwent tracheal intubation in the general care units. INTERVENTIONS A standardized data collection form was used prospectively to record events at the time of intubation. Patient outcomes were extracted from the medical record. MEASUREMENTS AND MAIN RESULTS The complication rate was 27%. The most common complications were multiple attempts (9% required>2 intubations) and esophageal intubation (9%). The complication rate for elective intubation (22%) was similar to the complication rate for emergent intubations (27%). Of patients intubated in the general care units, 52% survived and 33% of these were discharged. There was no significant difference (P=0.46) in survival between the patients intubated electively (59%) and emergently (50%). There was no significant difference (P=0.63) in survival between patients with (48%) and without complications (54%). CONCLUSIONS Endotracheal intubation in general hospital units carries a high rate of complications, and patients who are intubated in general hospital units have a high mortality.

[1]  M. Matthay,et al.  Death and Other Complications of Emergency Airway Management in Critically Ill Adults: A Prospective Investigation of 297 Tracheal Intubations , 1995, Anesthesiology.

[2]  D. E. Potts,et al.  Emergency Room Intubations-Complications and Survival , 1979 .

[3]  N. Marchionni,et al.  Cardiopulmonary resuscitation of older, inhospital patients: Immediate efficacy and long-term outcome , 2000, Critical care medicine.

[4]  M. Cupa,et al.  In-hospital and long-term prognosis of elderly patients requiring endotracheal intubation for life-threatening presentation of cardiogenic pulmonary edema , 2001, Critical care medicine.

[5]  J. Martyn,et al.  Succinylcholine-induced Hyperkalemia in Acquired Pathologic States: Etiologic Factors and Molecular Mechanisms , 2006, Anesthesiology.

[6]  J. Li,et al.  Complications of emergency intubation with and without paralysis. , 1999, The American journal of emergency medicine.

[7]  C. Borel,et al.  Survival and outcome after endotracheal intubation for acute stroke , 1999, Neurology.

[8]  T. Mort,et al.  Emergency Tracheal Intubation: Complications Associated with Repeated Laryngoscopic Attempts , 2004, Anesthesia and analgesia.

[9]  Edward A. Walton,et al.  Death and other complications of emergency airway management in critically ill adults , 1995 .

[10]  Rinaldo Bellomo,et al.  Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates* , 2004, Critical care medicine.

[11]  J. Marx,et al.  Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. , 1999, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[12]  J. Sakles,et al.  Airway management in the emergency department: a one-year study of 610 tracheal intubations. , 1998, Annals of emergency medicine.

[13]  V. F. Blanc,et al.  The Complications of Tracheal Intubation: A New Classification With a Review of the Literature , 1974, Anesthesia and analgesia.