Reintubation in the ICU following cardiac surgery: is it more difficult than first-time intubation in the operating room?: A prospective observational study.
Eur J Anaesthesiol
; 37(1): 25-30, 2020 Jan.
Article
em En
| MEDLINE
| ID: mdl-31107352
ABSTRACT
BACKGROUND:
After cardiac surgery, a patient's trachea is usually extubated; however, 2 to 13% of cardiac surgery patients require reintubation in the ICU.OBJECTIVE:
The objective of this study was to compare the initial intubation in the cardiac operating room with reintubation (if required) in the ICU following cardiac surgery.DESIGN:
A prospective, observational study.SETTING:
Department of Anesthesiology and Intensive Care Medicine, Clinical Hospital of Santiago, Spain. PATIENTS With approval of the local ethics committee, over a 44-month period, we prospectively enrolled all cardiac surgical patients who were intubated in the operating room using direct laryngoscopy, and who required reintubation later in the ICU. MAIN OUTCOMEMEASURES:
The primary endpoint was to compare first-time success rates for intubation in the operating room and ICU. Secondary endpoints were to compare the technical difficulties of intubation (modified Cormack-Lehane glottic view, operator-reported difficulty of intubation, need for support devices for direct laryngoscopy) and the incidence of complications.RESULTS:
A total of 122 cardiac surgical patients required reintubation in the ICU. Reintubation was associated with a lower first-time success rate than in the operating room (88.5 vs. 97.6%, Pâ=â0.0048). Reintubation in the ICU was associated with a higher incidence of Cormack-Lehane grades IIb, III or IV views (34.5 vs. 10.7%, Pâ<â0.0001), a higher incidence of moderate or difficult intubation (17.2 vs. 6.5%, Pâ=â0.0001) and a greater need for additional support during direct laryngoscopy (20.5 vs. 10.7%, Pâ=â0.005). Complications were more common during reintubations in the ICU (39.3 vs. 5.7%, Pâ<â0.0001).CONCLUSION:
Compared with intubations in the operating room, reintubation of cardiac surgical patients in the ICU was associated with more technical difficulties and a higher incidence of complications. CLINICAL TRIAL NUMBER Ethics committee of Galicia number 2015-012.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Reoperação
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Procedimentos Cirúrgicos Cardíacos
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Unidades de Terapia Intensiva
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Intubação Intratraqueal
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Laringoscopia
Tipo de estudo:
Etiology_studies
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Incidence_studies
/
Observational_studies
/
Prognostic_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article