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Defining Successful Intubation on the First Attempt Using Both Laryngoscope and Endotracheal Tube Insertions: A Secondary Analysis of Clinical Trial Data.
Trent, Stacy A; Driver, Brian E; Prekker, Matthew E; Barnes, Christopher R; Brewer, Joseph M; Doerschug, Kevin C; Gaillard, John P; Gibbs, Kevin W; Ghamande, Shekhar; Hughes, Christopher G; Janz, David R; Khan, Akram; Mitchell, Steven H; Page, David B; Rice, Todd W; Russell, Derek W; Self, Wesley H; Smith, Lane M; Stempek, Susan; Vonderhaar, Derek J; West, Jason R; Whitson, Micah R; Ginde, Adit A; Casey, Jonathan D; Semler, Matthew W.
Afiliação
  • Trent SA; Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. Electronic address: stacy.trent@dhha.org.
  • Driver BE; Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
  • Prekker ME; Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Division of Pulmonary, Allergy, and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN.
  • Barnes CR; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
  • Brewer JM; Division of Pulmonary, Critical Care, and Sleep Medicine and Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
  • Doerschug KC; Department of Internal Medicine, University of Iowa, Iowa City, IA.
  • Gaillard JP; Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
  • Gibbs KW; Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest Baptist Health, Winston-Salem, NC.
  • Ghamande S; Division of Pulmonary Disease and Critical Care Medicine Baylor Scott & White, Department of Medicine, Temple, TX.
  • Hughes CG; Department of Anesthesiology, Vanderbilt University Medical Center, Division of Pulmonary, Allergy, Nashville, TN.
  • Janz DR; Department of Pulmonary and Critical Care, University Medical Center New Orleans, New Orleans, LA; Department of Medicine, Section of Allergy/Immunology & Pulmonary/Critical Care, Louisiana State University School of Medicine, New Orleans, LA.
  • Khan A; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland, OR.
  • Mitchell SH; Department of Emergency Medicine, University of Washington, Seattle, WA.
  • Page DB; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.
  • Rice TW; Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • Russell DW; Department of Medicine, Section of Pulmonary, Birmingham Veteran's Affairs Medical Center, Birmingham, AL.
  • Self WH; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • Smith LM; Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, NC.
  • Stempek S; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA.
  • Vonderhaar DJ; Department of Pulmonary and Critical Care Medicine, Ochsner Health System, New Orleans, LA.
  • West JR; Department of Emergency Medicine, Lincoln Medical Center, Bronx, NY.
  • Whitson MR; Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.
  • Ginde AA; Department of Emergency Medicine, Denver Health Medical Center, Denver, CO.
  • Casey JD; Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
  • Semler MW; Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Ann Emerg Med ; 82(4): 432-437, 2023 10.
Article em En | MEDLINE | ID: mdl-37074254
STUDY OBJECTIVES: Successful intubation on the first attempt has historically been defined as successful placement of an endotracheal tube (ETT) using a single laryngoscope insertion. More recent studies have defined successful placement of an ETT using a single laryngoscope insertion followed by a single ETT insertion. We sought to estimate the prevalence of first-attempt success using these 2 definitions and estimate their associations with the duration of intubation and serious complications. METHODS: We performed a secondary analysis of data from 2 multicenter randomized trials of critically ill adults being intubated in the emergency department or ICU. We calculated the percent difference in successful intubations on the first attempt, median difference in the duration of intubation, and percent difference in the development of serious complications by definition. RESULTS: The study population included 1,863 patients. Successful intubation on the first attempt decreased by 4.9% (95% confidence interval 2.5% to 7.3%) when defined as 1 laryngoscope insertion followed by 1 ETT insertion (81.2%) compared with when defined as only 1 laryngoscope insertion (86.0%). When successful intubation with 1 laryngoscope and 1 ETT insertion was compared with 1 laryngoscope and multiple ETT insertions, the median duration of intubation decreased by 35.0 seconds (95% confidence interval 8.9 to 61.1 seconds). CONCLUSION: Defining successful intubation on the first attempt as placement of an ETT in the trachea using 1 laryngoscope and 1 ETT insertion identifies attempts with the shortest apneic time.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Laringoscópios Tipo de estudo: Clinical_trials / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Ann Emerg Med Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Laringoscópios Tipo de estudo: Clinical_trials / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Ann Emerg Med Ano de publicação: 2023 Tipo de documento: Article