How to Prevent Death by Intubation

Written by Clay Smith

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Peri-intubation arrest is common.  Here are several ways you can avoid it.

Why does this matter?
Intubation of critically ill patients is no small matter and is a vulnerable period of time for the patient.  Optimizing all possible variables gives patients with best chance to survive.  Don't miss Scott Weingart's Laryngoscope as a Murder Weapon series.

Death by endotracheal tube
Of 1,847 intubations in 64 French ICUs, 2.7% arrested during intubation.  Of these, 29% were not able to be resuscitated.  Not surprisingly for the rest, peri-intubation arrest was an independent risk factor for 28-day mortality.  They found the following clinical variables were associated with increased risk of arrest:

  • hypotension
  • hypoxemia
  • absence of preoxygenation
  • obesity
  • age over 75.

We can usually modify 3 out of the 5.  And we can prepare for and ramp obese patients.  The only thing we can't do is make patients younger.  So if we don't want to use the laryngoscope as a murder weapon, let's optimize all the variables we can prior to intubation.

Source
Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study.  Crit Care Med. 2018 Apr;46(4):532-539. doi: 10.1097/CCM.0000000000002925.

Peer reviewed by Thomas Davis

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