Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study
BACKGROUND:Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared wi...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2018-08, Vol.129 (2), p.321-328 |
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| creator | Taboada, Manuel Doldan, Patricia Calvo, Andrea Almeida, Xavier Ferreiroa, Esteban Baluja, Aurora Cariñena, Agustin Otero, Paula Caruezo, Valentin Naveira, Alberto Otero, Pablo Alvarez, Julian |
| description | BACKGROUND:Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room.
METHODS:The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications.
RESULTS:A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001).
CONCLUSIONS:Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications. |
| doi_str_mv | 10.1097/ALN.0000000000002269 |
| format | Article |
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METHODS:The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications.
RESULTS:A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001).
CONCLUSIONS:Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/ALN.0000000000002269</identifier><identifier>PMID: 29787386</identifier><language>eng</language><publisher>United States: Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc</publisher><subject>Aged ; Aged, 80 and over ; Airway Management - adverse effects ; Airway Management - methods ; Airway Management - standards ; Female ; Humans ; Hypotension - diagnosis ; Hypotension - etiology ; Hypoxia - diagnosis ; Hypoxia - etiology ; Intensive Care Units - standards ; Intubation, Intratracheal - adverse effects ; Intubation, Intratracheal - methods ; Intubation, Intratracheal - standards ; Male ; Middle Aged ; Operating Rooms - methods ; Operating Rooms - standards ; Prospective Studies</subject><ispartof>Anesthesiology (Philadelphia), 2018-08, Vol.129 (2), p.321-328</ispartof><rights>Copyright © by 2018, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29787386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taboada, Manuel</creatorcontrib><creatorcontrib>Doldan, Patricia</creatorcontrib><creatorcontrib>Calvo, Andrea</creatorcontrib><creatorcontrib>Almeida, Xavier</creatorcontrib><creatorcontrib>Ferreiroa, Esteban</creatorcontrib><creatorcontrib>Baluja, Aurora</creatorcontrib><creatorcontrib>Cariñena, Agustin</creatorcontrib><creatorcontrib>Otero, Paula</creatorcontrib><creatorcontrib>Caruezo, Valentin</creatorcontrib><creatorcontrib>Naveira, Alberto</creatorcontrib><creatorcontrib>Otero, Pablo</creatorcontrib><creatorcontrib>Alvarez, Julian</creatorcontrib><title>Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>BACKGROUND:Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room.
METHODS:The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications.
RESULTS:A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001).
CONCLUSIONS:Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Airway Management - adverse effects</subject><subject>Airway Management - methods</subject><subject>Airway Management - standards</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - diagnosis</subject><subject>Hypotension - etiology</subject><subject>Hypoxia - diagnosis</subject><subject>Hypoxia - etiology</subject><subject>Intensive Care Units - standards</subject><subject>Intubation, Intratracheal - adverse effects</subject><subject>Intubation, Intratracheal - methods</subject><subject>Intubation, Intratracheal - standards</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Operating Rooms - methods</subject><subject>Operating Rooms - standards</subject><subject>Prospective Studies</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1P3DAQhq2qqLss_IMK-dhDA_6Ik7i3VUQBacWiFs6WY892A4md2gkIfj1ePiTEXGbmnUfvYV6EvlNyTIksT5ary2PyoRgr5Bc0p4JVGaWl-IrmSeUZT5cZ2o_xNq2l4NU3NGOyrEpeFXP0VPt-0KGN3mG_wddBmy3oDl-4cWr02Ca59s62uyni1uH1ACHp7h_-432PtbM7Flxs7wHXOgC-ce34Cy_xVfBxADOmw0-8biKE-xfD5P53nOzjAdrb6C7C4VtfoJvfp9f1ebZan13Uy1U2sILIjAlLmabWNFqWJcsFIVAYzimXkLOiYMwQYTjJDbcyF6xpQOdGWmM1J0Vh-QL9ePUdgv8_QRxV30YDXacd-CkqRnJOKyqkSOjRGzo1PVg1hLbX4VG9_ysB1Svw4LsRQrzrpgcIaveycasoUbtoVIpGfY6GPwN2xX9V</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Taboada, Manuel</creator><creator>Doldan, Patricia</creator><creator>Calvo, Andrea</creator><creator>Almeida, Xavier</creator><creator>Ferreiroa, Esteban</creator><creator>Baluja, Aurora</creator><creator>Cariñena, Agustin</creator><creator>Otero, Paula</creator><creator>Caruezo, Valentin</creator><creator>Naveira, Alberto</creator><creator>Otero, Pablo</creator><creator>Alvarez, Julian</creator><general>Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20180801</creationdate><title>Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study</title><author>Taboada, Manuel ; Doldan, Patricia ; Calvo, Andrea ; Almeida, Xavier ; Ferreiroa, Esteban ; Baluja, Aurora ; Cariñena, Agustin ; Otero, Paula ; Caruezo, Valentin ; Naveira, Alberto ; Otero, Pablo ; Alvarez, Julian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2609-25d12a1dcba97724500e6c33139e426622c05c304c3d9452bbea4c9dcda3066d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Airway Management - adverse effects</topic><topic>Airway Management - methods</topic><topic>Airway Management - standards</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - diagnosis</topic><topic>Hypotension - etiology</topic><topic>Hypoxia - diagnosis</topic><topic>Hypoxia - etiology</topic><topic>Intensive Care Units - standards</topic><topic>Intubation, Intratracheal - adverse effects</topic><topic>Intubation, Intratracheal - methods</topic><topic>Intubation, Intratracheal - standards</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Operating Rooms - methods</topic><topic>Operating Rooms - standards</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taboada, Manuel</creatorcontrib><creatorcontrib>Doldan, Patricia</creatorcontrib><creatorcontrib>Calvo, Andrea</creatorcontrib><creatorcontrib>Almeida, Xavier</creatorcontrib><creatorcontrib>Ferreiroa, Esteban</creatorcontrib><creatorcontrib>Baluja, Aurora</creatorcontrib><creatorcontrib>Cariñena, Agustin</creatorcontrib><creatorcontrib>Otero, Paula</creatorcontrib><creatorcontrib>Caruezo, Valentin</creatorcontrib><creatorcontrib>Naveira, Alberto</creatorcontrib><creatorcontrib>Otero, Pablo</creatorcontrib><creatorcontrib>Alvarez, Julian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taboada, Manuel</au><au>Doldan, Patricia</au><au>Calvo, Andrea</au><au>Almeida, Xavier</au><au>Ferreiroa, Esteban</au><au>Baluja, Aurora</au><au>Cariñena, Agustin</au><au>Otero, Paula</au><au>Caruezo, Valentin</au><au>Naveira, Alberto</au><au>Otero, Pablo</au><au>Alvarez, Julian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>129</volume><issue>2</issue><spage>321</spage><epage>328</epage><pages>321-328</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><abstract>BACKGROUND:Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room.
METHODS:The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications.
RESULTS:A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001).
CONCLUSIONS:Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications.</abstract><cop>United States</cop><pub>Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc</pub><pmid>29787386</pmid><doi>10.1097/ALN.0000000000002269</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Airway Management - adverse effects Airway Management - methods Airway Management - standards Female Humans Hypotension - diagnosis Hypotension - etiology Hypoxia - diagnosis Hypoxia - etiology Intensive Care Units - standards Intubation, Intratracheal - adverse effects Intubation, Intratracheal - methods Intubation, Intratracheal - standards Male Middle Aged Operating Rooms - methods Operating Rooms - standards Prospective Studies |
| title | Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit: A Prospective, Observational Study |
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