Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation

Study objective Desaturation during intubation has been associated with serious complications, including dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and cardiac arrest. We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid s...

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Veröffentlicht in:Annals of emergency medicine 2016-03, Vol.67 (3), p.389-395
Hauptverfasser: Bodily, Jerry B., MD, Webb, Heather R., MD, Weiss, Steve J., MD, Braude, Darren A., MD
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container_end_page 395
container_issue 3
container_start_page 389
container_title Annals of emergency medicine
container_volume 67
creator Bodily, Jerry B., MD
Webb, Heather R., MD
Weiss, Steve J., MD
Braude, Darren A., MD
description Study objective Desaturation during intubation has been associated with serious complications, including dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and cardiac arrest. We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid sequence intubation. Methods This study included adult rapid sequence intubation cases conducted between September 2011 and July 2012 in an urban, academic, Level I trauma center ED. We obtained continuous vital signs with BedMasterEX data acquisition software. Start and completion times of rapid sequence intubation originated from nursing records. We defined oxygen desaturation as (1) cases exhibiting SpO2 reduction to less than 90% if the starting SpO2 was greater than or equal to 90%, or (2) a further reduction in SpO2 in cases in which starting SpO2 was less than 90%. We used multivariable logistic regression to predict oxygen desaturation during rapid sequence intubation. Results During the study period, there were 265 rapid sequence intubation cases. The study excluded 99 cases for failure of electronic data acquisition, inadequate documentation, or poor SpO2 waveform during rapid sequence intubation, and excluded cases managed by anesthesia providers, leaving 166 patients in the analysis. After preoxygenation, starting SpO2 was greater than 93% in 124 of 166 cases (75%) and SpO2 was less than 93% in the remaining 46 cases. Oxygen desaturation occurred in 59 patients (35.5%). The median duration of desaturation was 80 seconds (interquartile range 40, 155). Multivariable analysis demonstrated that oxygen desaturation was associated with preintubation SpO2 less than 93% (odds ratio [OR] 5.1; 95% confidence interval (CI) 2.3 to 11.0), multiple intubation attempts (>1 attempt) (OR 3.4; 95% CI 1.4 to 6.1), and rapid sequence intubation duration greater than 3 minutes (OR 2.7; 95% CI 1.2 to 6.1). Conclusion In this series, 1 in 3 patients undergoing ED rapid sequence intubation experienced oxygen desaturation for a median duration of 80 seconds. Preintubation saturation less than 93%, multiple intubation attempts, and prolonged intubation time are independently associated with oxygen desaturation. Clinicians should use strategies to prevent oxygen desaturation during ED rapid sequence intubation.
doi_str_mv 10.1016/j.annemergmed.2015.06.006
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We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid sequence intubation. Methods This study included adult rapid sequence intubation cases conducted between September 2011 and July 2012 in an urban, academic, Level I trauma center ED. We obtained continuous vital signs with BedMasterEX data acquisition software. Start and completion times of rapid sequence intubation originated from nursing records. We defined oxygen desaturation as (1) cases exhibiting SpO2 reduction to less than 90% if the starting SpO2 was greater than or equal to 90%, or (2) a further reduction in SpO2 in cases in which starting SpO2 was less than 90%. We used multivariable logistic regression to predict oxygen desaturation during rapid sequence intubation. Results During the study period, there were 265 rapid sequence intubation cases. The study excluded 99 cases for failure of electronic data acquisition, inadequate documentation, or poor SpO2 waveform during rapid sequence intubation, and excluded cases managed by anesthesia providers, leaving 166 patients in the analysis. After preoxygenation, starting SpO2 was greater than 93% in 124 of 166 cases (75%) and SpO2 was less than 93% in the remaining 46 cases. Oxygen desaturation occurred in 59 patients (35.5%). The median duration of desaturation was 80 seconds (interquartile range 40, 155). Multivariable analysis demonstrated that oxygen desaturation was associated with preintubation SpO2 less than 93% (odds ratio [OR] 5.1; 95% confidence interval (CI) 2.3 to 11.0), multiple intubation attempts (&gt;1 attempt) (OR 3.4; 95% CI 1.4 to 6.1), and rapid sequence intubation duration greater than 3 minutes (OR 2.7; 95% CI 1.2 to 6.1). Conclusion In this series, 1 in 3 patients undergoing ED rapid sequence intubation experienced oxygen desaturation for a median duration of 80 seconds. Preintubation saturation less than 93%, multiple intubation attempts, and prolonged intubation time are independently associated with oxygen desaturation. Clinicians should use strategies to prevent oxygen desaturation during ED rapid sequence intubation.</description><identifier>ISSN: 0196-0644</identifier><identifier>EISSN: 1097-6760</identifier><identifier>DOI: 10.1016/j.annemergmed.2015.06.006</identifier><identifier>PMID: 26164643</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Emergency ; Emergency Service, Hospital ; Female ; Hospitals, Urban ; Humans ; Hypoxia - epidemiology ; Hypoxia - etiology ; Incidence ; Intubation, Intratracheal - adverse effects ; Laryngoscopy ; Male ; Middle Aged ; Oximetry ; Oxygen - administration &amp; dosage ; Oxygen - blood ; Time Factors ; Vital Signs</subject><ispartof>Annals of emergency medicine, 2016-03, Vol.67 (3), p.389-395</ispartof><rights>American College of Emergency Physicians</rights><rights>2015 American College of Emergency Physicians</rights><rights>Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-68e20132589a7931c91a894a855b8fadfe7215d3cbe7ba1055688bf02f30b0113</citedby><cites>FETCH-LOGICAL-c483t-68e20132589a7931c91a894a855b8fadfe7215d3cbe7ba1055688bf02f30b0113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.annemergmed.2015.06.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26164643$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bodily, Jerry B., MD</creatorcontrib><creatorcontrib>Webb, Heather R., MD</creatorcontrib><creatorcontrib>Weiss, Steve J., MD</creatorcontrib><creatorcontrib>Braude, Darren A., MD</creatorcontrib><title>Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation</title><title>Annals of emergency medicine</title><addtitle>Ann Emerg Med</addtitle><description>Study objective Desaturation during intubation has been associated with serious complications, including dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and cardiac arrest. We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid sequence intubation. Methods This study included adult rapid sequence intubation cases conducted between September 2011 and July 2012 in an urban, academic, Level I trauma center ED. We obtained continuous vital signs with BedMasterEX data acquisition software. Start and completion times of rapid sequence intubation originated from nursing records. We defined oxygen desaturation as (1) cases exhibiting SpO2 reduction to less than 90% if the starting SpO2 was greater than or equal to 90%, or (2) a further reduction in SpO2 in cases in which starting SpO2 was less than 90%. We used multivariable logistic regression to predict oxygen desaturation during rapid sequence intubation. Results During the study period, there were 265 rapid sequence intubation cases. The study excluded 99 cases for failure of electronic data acquisition, inadequate documentation, or poor SpO2 waveform during rapid sequence intubation, and excluded cases managed by anesthesia providers, leaving 166 patients in the analysis. After preoxygenation, starting SpO2 was greater than 93% in 124 of 166 cases (75%) and SpO2 was less than 93% in the remaining 46 cases. Oxygen desaturation occurred in 59 patients (35.5%). The median duration of desaturation was 80 seconds (interquartile range 40, 155). Multivariable analysis demonstrated that oxygen desaturation was associated with preintubation SpO2 less than 93% (odds ratio [OR] 5.1; 95% confidence interval (CI) 2.3 to 11.0), multiple intubation attempts (&gt;1 attempt) (OR 3.4; 95% CI 1.4 to 6.1), and rapid sequence intubation duration greater than 3 minutes (OR 2.7; 95% CI 1.2 to 6.1). Conclusion In this series, 1 in 3 patients undergoing ED rapid sequence intubation experienced oxygen desaturation for a median duration of 80 seconds. Preintubation saturation less than 93%, multiple intubation attempts, and prolonged intubation time are independently associated with oxygen desaturation. Clinicians should use strategies to prevent oxygen desaturation during ED rapid sequence intubation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cross-Sectional Studies</subject><subject>Emergency</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Hospitals, Urban</subject><subject>Humans</subject><subject>Hypoxia - epidemiology</subject><subject>Hypoxia - etiology</subject><subject>Incidence</subject><subject>Intubation, Intratracheal - adverse effects</subject><subject>Laryngoscopy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oximetry</subject><subject>Oxygen - administration &amp; dosage</subject><subject>Oxygen - blood</subject><subject>Time Factors</subject><subject>Vital Signs</subject><issn>0196-0644</issn><issn>1097-6760</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc2O1DAQhC0EYoeFV0DmxiWhnR_HviCh2QVGWrQH4Gw5TmfkkDiD7azI2-MwOxLixMmHrqp2fU3IGwY5A8bfDbl2Dif0xwm7vABW58BzAP6E7BjIJuMNh6dkB0zyDHhVXZEXIQwAIKuCPSdXBWe84lW5I8PBGduhM0i16-jN4nW0s6NzT_ezi9Yt8xLGlX5BHRaPHb3_tR7R0RsMOl7EyWXdkd5uP0pRa5qetI8TukgPLi7tH9lL8qzXY8BXj-81-f7x9tv-c3Z3_-mw_3CXmUqUMeMCU6OyqIXUjSyZkUwLWWlR163odddjU7C6K02LTasZ1DUXou2h6EtogbHymrw95578_HPBENVkg8Fx1A5TGcUanrKkaDapPEuNn0Pw2KuTt5P2q2KgNtRqUH-hVhtqBVwl1Mn7-nHN0m6zi_PCNgn2ZwGmsg8WvQrGbqQ769FE1c32v9a8_yfFjNZZo8cfuGIY5sW7RFMxFQoF6ut28-3krAaoBC_K3xJdq7o</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Bodily, Jerry B., MD</creator><creator>Webb, Heather R., MD</creator><creator>Weiss, Steve J., MD</creator><creator>Braude, Darren A., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160301</creationdate><title>Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation</title><author>Bodily, Jerry B., MD ; Webb, Heather R., MD ; Weiss, Steve J., MD ; Braude, Darren A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-68e20132589a7931c91a894a855b8fadfe7215d3cbe7ba1055688bf02f30b0113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cross-Sectional Studies</topic><topic>Emergency</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Hospitals, Urban</topic><topic>Humans</topic><topic>Hypoxia - epidemiology</topic><topic>Hypoxia - etiology</topic><topic>Incidence</topic><topic>Intubation, Intratracheal - adverse effects</topic><topic>Laryngoscopy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Oximetry</topic><topic>Oxygen - administration &amp; dosage</topic><topic>Oxygen - blood</topic><topic>Time Factors</topic><topic>Vital Signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bodily, Jerry B., MD</creatorcontrib><creatorcontrib>Webb, Heather R., MD</creatorcontrib><creatorcontrib>Weiss, Steve J., MD</creatorcontrib><creatorcontrib>Braude, Darren A., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bodily, Jerry B., MD</au><au>Webb, Heather R., MD</au><au>Weiss, Steve J., MD</au><au>Braude, Darren A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation</atitle><jtitle>Annals of emergency medicine</jtitle><addtitle>Ann Emerg Med</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>67</volume><issue>3</issue><spage>389</spage><epage>395</epage><pages>389-395</pages><issn>0196-0644</issn><eissn>1097-6760</eissn><abstract>Study objective Desaturation during intubation has been associated with serious complications, including dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and cardiac arrest. We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid sequence intubation. Methods This study included adult rapid sequence intubation cases conducted between September 2011 and July 2012 in an urban, academic, Level I trauma center ED. We obtained continuous vital signs with BedMasterEX data acquisition software. Start and completion times of rapid sequence intubation originated from nursing records. We defined oxygen desaturation as (1) cases exhibiting SpO2 reduction to less than 90% if the starting SpO2 was greater than or equal to 90%, or (2) a further reduction in SpO2 in cases in which starting SpO2 was less than 90%. We used multivariable logistic regression to predict oxygen desaturation during rapid sequence intubation. Results During the study period, there were 265 rapid sequence intubation cases. The study excluded 99 cases for failure of electronic data acquisition, inadequate documentation, or poor SpO2 waveform during rapid sequence intubation, and excluded cases managed by anesthesia providers, leaving 166 patients in the analysis. After preoxygenation, starting SpO2 was greater than 93% in 124 of 166 cases (75%) and SpO2 was less than 93% in the remaining 46 cases. Oxygen desaturation occurred in 59 patients (35.5%). The median duration of desaturation was 80 seconds (interquartile range 40, 155). Multivariable analysis demonstrated that oxygen desaturation was associated with preintubation SpO2 less than 93% (odds ratio [OR] 5.1; 95% confidence interval (CI) 2.3 to 11.0), multiple intubation attempts (&gt;1 attempt) (OR 3.4; 95% CI 1.4 to 6.1), and rapid sequence intubation duration greater than 3 minutes (OR 2.7; 95% CI 1.2 to 6.1). Conclusion In this series, 1 in 3 patients undergoing ED rapid sequence intubation experienced oxygen desaturation for a median duration of 80 seconds. Preintubation saturation less than 93%, multiple intubation attempts, and prolonged intubation time are independently associated with oxygen desaturation. Clinicians should use strategies to prevent oxygen desaturation during ED rapid sequence intubation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26164643</pmid><doi>10.1016/j.annemergmed.2015.06.006</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Emergency
Emergency Service, Hospital
Female
Hospitals, Urban
Humans
Hypoxia - epidemiology
Hypoxia - etiology
Incidence
Intubation, Intratracheal - adverse effects
Laryngoscopy
Male
Middle Aged
Oximetry
Oxygen - administration & dosage
Oxygen - blood
Time Factors
Vital Signs
title Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation
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