Out of Intensive Care and Operating Theatre Intubations: Prospective Observational Study

Tracheal intubations are not infrequent out of ICUs and operating theatres and carry a substantial risk of adverse events. Our objective was to study the current practices of tracheal intubations in medical wards of the national hospital of Sri Lanka (NHSL). A prospective observational study was performed among all adult patients who had an endotracheal intubation in a medical ward of NHSL over a 6-month period. There were 47 intubations. Majority, 29 (61.7%) of intubations occurred during out of hours (after 4pm) and 23 (48.9%) of them were emergency intubations. Most common reason for intubation was respiratory distress 26 (55.3%). Other indications were cardiac arrest 11 (23.4%), Low GCS 7 (14.9%) and shock 2 (4.3%). Capnography and 2 laryngoscopes were not available during any of the intubations. Bougie was available only in 23 (48.9%) cases and alternative airway equipment were available only in 9 (19.1) cases. Midazolam was the most common induction agent 34 (72.3%). Majority 27 (57.4%) of the intubators had less than 6 months of experience in anaesthesia. Most of the intubations 32 (68.1%) were done by a registrar and 6 (12.8%) were done by an intern medical officer. There were 39 adverse events during all intubations and hypotension 14 (29.8%) was the most frequent adverse event. Therefore, we conclude that intubations in medical wards are done by less experienced doctors with lack of facilities and has high incidence of adverse events.