Incidence of aspiration after urgent intubation

• Published in: The American journal of emergency medicine Vol. 15; no. 6; pp. 562 - 565
• Main Authors: Thibodeau, Lorraine G, Verdile, Vincent P, Bartfield, Joel M
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.10.1997; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; aspiration; Biological and medical sciences; Child; Clinical Competence; Emergencies; Emergency and intensive respiratory care; emergency department; Humans; Incidence; Intensive care medicine; Internship and Residency; Intubation; Intubation, Intratracheal - adverse effects; Medical sciences; Medical Staff, Hospital - education; Pneumonia, Aspiration - diagnosis; Pneumonia, Aspiration - etiology; Retrospective Studies; Risk Factors; Trauma Centers; emergency department; aspiration; Intubation; Human; Lung disease; Iatrogenic; Respiratory disease; Aspiration pneumonia; Hospital ward; Complication; Emergency; Trachea; Trauma; Incidence
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/S0735-6757(97)90157-1

This study sought to determine the incidence of aspiration after urgent endotracheal intubation (ET) performed in the emergency department (ED), and to offer a descriptive evaluation of these intubations. In a retrospective review of 133 charts, 87 patients met inclusion criteria. Aspiration occurred in 3 (3.5%) patients (95% confidence interval, 0%, 7.4%). One had witnessed aspiration, and 2 had positive sputum cultures. None of the 87 patients had a positive chest radiograph or unexplained hypoxemia up to 48 hours after ET. Rapid-sequence induction and oral ET was performed in 79 (91%) patients, whereas 4 spontaneously breathing patients were nasally intubated. Seventy percent of patients underwent ET by PGY I or II residents, 29% by PGY III or IV residents, and 1% by ED attending physicians. Seventy-seven patients were intubated on the first attempt, and airway blood or vomitus during ET was noted in 11 patients. This study offers significant descriptive information regarding urgent ET performed in the ED, and shows that aspiration after urgent ET occurs infrequently in ED patients.