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An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study

Samir Jaber| Boris Jung| Philippe Corne| Mustapha Sebbane| Laurent Muller| Gerald Chanques| Daniel Verzilli| Olivier Jonquet| Jean-Jacques Eledjam| Jean-Yves Lefrant
Original
Volume 36, Issue 2 / February , 2010

Pages 248 - 255

Abstract

Objective

To determined whether the implementation of an intubation management protocol leads to the reduction of intubation-related complications in the intensive care unit (ICU).

Design

Two-phase, prospective, multicenter controlled study.

Setting

Three medical-surgical ICUs in two university hospitals.

Patients

Two hundred three consecutive ICU patients required 244 intubations.

Interventions

All intubations performed during two consecutive phases (a 6-month quality control phase followed by a 6-month intervention phase based on the implementation of an ICU intubation bundle management protocol) were evaluated. The ten bundle components were: preoxygenation with noninvasive positive pressure ventilation, presence of two operators, rapid sequence induction, cricoid pressure, capnography, protective ventilation, fluid loading, preparation and early administration of sedation and vasopressor use if needed.

Measurements and main results

The primary end points were the incidence of life-threatening complications occurring within 60 min after intubation (cardiac arrest or death, severe cardiovascular collapse and hypoxemia). Other complications (mild to moderate) were also evaluated. Baseline characteristics, including demographic data and reason for intubation (mainly acute respiratory failure), were similar in the two phases. The intubation procedure in the intervention phase (n = 121) was associated with significant decreases in both life-threatening complications (21 vs. 34%, p = 0.03) and other complications (9 vs. 21%, p = 0.01) compared to the control phase (n = 123).

Conclusions

The implementation of an intubation management protocol can reduce immediate severe life-threatening complications associated with intubation of ICU patients.

Keywords

References

  1. Baillard C, Fosse JP, Sebbane M, Chanques G, Vincent F, Courouble P, Cohen Y, Eledjam JJ, Adnet F, Jaber S (2006) Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med 174:171–177
    • View reference on publisher's website
    • View reference on PubMed
  2. Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L, Calvet Y, Capdevila X, Mahamat A, Eledjam JJ (2006) Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 34:2355–2361
    • View reference on publisher's website
    • View reference on PubMed
  3. Mort TC, Waberski BH, Clive J (2009) Extending the preoxygenation period from 4 to 8 mins in critically ill patients undergoing emergency intubation. Crit Care Med 37:68–71
    • View reference on publisher's website
    • View reference on PubMed
  4. Petrini F, Accorsi A, Adrario E, Agro F, Amicucci G, Antonelli M, Azzeri F, Baroncini S, Bettelli G, Cafaggi C, Cattano D, Chinelli E, Corbanese U, Corso R, Della Puppa A, Di Filippo A, Facco E, Favaro R, Favero R, Frova G, Giunta F, Giurati G, Giusti F, Guarino A, Iannuzzi E, Ivani G, Mazzon D, Menarini M, Merli G, Mondello E, Muttini S, Nardi G, Pigna A, Pittoni G, Ripamonti D, Rosa G, Rosi R, Salvo I, Sarti A, Serafini G, Servadio G, Sgandurra A, Sorbello M, Tana F, Tufano R, Vesconi S, Villani A, Zauli M (2005) Recommendations for airway control and difficult airway management. Minerva Anestesiol 71:617–657
    • View reference on PubMed
  5. Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR (2008) Complications of endotracheal intubation in the critically ill. Intensive Care Med 34:1835–1842
  6. Le Tacon S, Wolter P, Rusterholtz T, Harlay M, Gayol S, Sauder P, Jaeger A (2000) Complications of difficult tracheal intubations in a critical care unit. Ann Fr Anesth Réanim 19:719–724
    • View reference on PubMed
  7. Schmidt UH, Kumwilaisak K, Bittner E, George E, Hess D (2008) Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation. Anesthesiology 109:973–977
    • View reference on publisher's website
    • View reference on PubMed
  8. Schwartz DE, Matthay MA, Cohen NH (1995) Death and other complications of emergency airway management in critically ill adults. Anesthesiology 82:367–376
    • View reference on publisher's website
    • View reference on PubMed
  9. (2003) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 98:1269–1277
  10. Adnet F, Jouriles NJ, Le Toumelin P, Hennequin B, Taillandier C, Rayeh F, Couvreur J, Nougiere B, Nadiras P, Ladka A, Fleury M (1998) Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study. Ann Emerg Med 32:454–460
    • View reference on publisher's website
    • View reference on PubMed
  11. Girault C, Auriant I, Jaber S (2008) Safety practices procedures for mechanical ventilation. Ann Fr Anesth Reanim 27:e77–e89
    • View reference on PubMed
  12. Smith DC, Bergen JM, Smithline H, Kirschner R (2000) A trial of etomidate for rapid sequence intubation in the emergency department. J Emerg Med 18:13–16
    • View reference on publisher's website
    • View reference on PubMed
  13. Leibowitz AB (2006) Tracheal intubation in the intensive care unit: extremely hazardous even in the best of hands. Crit Care Med 34:2497–2498
    • View reference on publisher's website
    • View reference on PubMed
  14. Delay JM, Sebbane M, Jung B, Nocca D, Verzilli D, Pouzeratte Y, Kamel ME, Fabre JM, Eledjam JJ, Jaber S (2008) The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study. Anesth Analg 107:1707–1713
    • View reference on publisher's website
    • View reference on PubMed
  15. Stiell IG, Spaite DW, Field B, Nesbitt LP, Munkley D, Maloney J, Dreyer J, Toohey LL, Campeau T, Dagnone E, Lyver M, Wells GA (2007) Advanced life support for out-of-hospital respiratory distress. N Engl J Med 356:2156–2164
    • View reference on publisher's website
    • View reference on PubMed
  16. Chanques G, Jaber S, Barbotte E, Violet S, Sebbane M, Perrigault PF, Mann C, Lefrant JY, Eledjam JJ (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 34:1691–1699
    • View reference on publisher's website
    • View reference on PubMed
  17. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–134
    • View reference on publisher's website
    • View reference on PubMed
  18. Ferrer R, Artigas A, Levy MM, Blanco J, Gonzalez-Diaz G, Garnacho-Montero J, Ibanez J, Palencia E, Quintana M, de la Torre-Prados MV (2008) Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 299:2294–2303
    • View reference on publisher's website
    • View reference on PubMed
  19. Micek ST, Roubinian N, Heuring T, Bode M, Williams J, Harrison C, Murphy T, Prentice D, Ruoff BE, Kollef MH (2006) Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med 34:2707–2713
    • View reference on publisher's website
    • View reference on PubMed
  20. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499
    • View reference on publisher's website
    • View reference on PubMed
  21. Reynolds SF, Heffner J (2005) Airway management of the critically ill patient: rapid-sequence intubation. Chest 127:1397–1412
    • View reference on publisher's website
    • View reference on PubMed
  22. Walz JM, Zayaruzny M, Heard SO (2007) Airway management in critical illness. Chest 131:608–620
    • View reference on publisher's website
    • View reference on PubMed
  23. Brattebo G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek PE (2002) Effect of a scoring system and protocol for sedation on duration of patients’ need for ventilator support in a surgical intensive care unit. BMJ 324:1386–1389
    • View reference on publisher's website
    • View reference on PubMed
  24. Schultz MJ, Haitsma JJ, Slutsky AS, Gajic O (2007) What tidal volumes should be used in patients without acute lung injury? Anesthesiology 106:1226–1231
    • View reference on publisher's website
    • View reference on PubMed
  25. Mort TC (2005) Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med 33:2672–2675
    • View reference on publisher's website
    • View reference on PubMed
  26. Jaber S, Delay JM, Chanques G, Sebbane M, Jacquet E, Souche B, Perrigault PF, Eledjam JJ (2005) Outcomes of patients with acute respiratory failure after abdominal surgery treated with noninvasive positive pressure ventilation. Chest 128:2688–2695
    • View reference on publisher's website
    • View reference on PubMed
  27. Jaber S, Fodil R, Carlucci A, Boussarsar M, Pigeot J, Lemaire F, Harf A, Lofaso F, Isabey D, Brochard L (2000) Noninvasive ventilation with helium-oxygen in acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 161:1191–1200
    • View reference on PubMed
  28. Donald MJ, Paterson B (2006) End tidal carbon dioxide monitoring in prehospital and retrieval medicine: a review. Emerg Med J 23:728–730
    • View reference on publisher's website
    • View reference on PubMed
  29. Walz JM, Heard SO (2005) Making tracheal intubation safer in the critically ill patient. Crit Care Med 33:2716–2717
    • View reference on publisher's website
    • View reference on PubMed
  30. Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty J, Kalenka A, Forst H, Laterre PF, Reinhart K, Cuthbertson BH, Payen D, Briegel J (2008) Hydrocortisone therapy for patients with septic shock. N Engl J Med 358:111–124
    • View reference on publisher's website
    • View reference on PubMed
  31. Kamp R, Kress JP (2007) Etomidate, sepsis, and adrenal function: not as bad as we thought? Crit Care 11:145
    • View reference on publisher's website
    • View reference on PubMed
  32. Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, Bertrand L, Beltramini A, Gamand P, Albizzati S, Perdrizet D, Lebail G, Chollet-Xemard C, Maxime V, Brun-Buisson C, Lefrant JY, Bollaert PE, Megarbane B, Ricard JD, Anguel N, Vicaut E, Adnet F (2009) Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet
  33. Jaber S, Chanques G, Altairac C, Sebbane M, Vergne C, Perrigault PF, Eledjam JJ (2005) A prospective study of agitation in a medical-surgical ICU: incidence, risk factors, and outcomes. Chest 128:2749–2757
    • View reference on publisher's website
    • View reference on PubMed
  34. Jaeschke R, Jankowski M, Brozek J, Antonelli M (2009) How to develop guidelines for clinical practice. Minerva Anestesiol 75:504–508
    • View reference on PubMed
  35. Baillard C, Jaber S (2007) NCT00472160 CT. Preoxygenation using NIV in hypoxemic patients (preoxy study)
  36. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on publisher's website
    • View reference on PubMed

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