Incidence of Difficult Intubation in Intensive Care Patients: Analysis of Contributing Factors

• Published in: Anaesthesia and intensive care Vol. 40; no. 1; pp. 120 - 127
• Main Authors: Heuer, J. F., Crozier, T. A., Barwing, J., Russo, S. G., Bleckmann, E., Quintel, M., MÖRer, O.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2012; Anaesthesia Society of Anaesthetists; Sage Publications Ltd. (UK); Sage Publications Ltd
• Subjects: Aged; Aged, 80 and over; Airway (Medicine); Algorithms; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Care and treatment; Critically ill; Diagnosis; Female; Fiber Optic Technology; Humans; Intensive Care Units; Intubation; Intubation, Intratracheal - instrumentation; Intubation, Intratracheal - methods; Laryngeal Masks; Laryngoscopy - methods; Male; Medical sciences; Middle Aged; Physiological aspects; Risk Factors; Trachea; Germany; intensive care medicine; difficult intubation; Human; Intensive care; Anesthesia; Intubation; Incidence
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X1204000113

Difficulties in endotracheal intubation increase morbidity and mortality in intensive care patients. We studied the problem in surgical intensive care patients with the aim of risk reduction. Patients intubated in the intensive care unit were evaluated. The intubations were performed or supervised by anaesthetists following the algorithm valid at the time of the study. Fifty percent of the 198 intubations were performed by specialist anaesthetists, 41.5% by anaesthesia trainees and 8.5% by surgical trainees. The initial attempt was by direct laryngoscopy (n=173), flexible fibrescope (n=8) or blind nasal technique (n=17). When direct laryngoscopy failed (n=7), intubation was accomplished with an intubating laryngeal mask airway (n=5), Frova stylet (n=1) or fibrescope (n=1). Thirty percent were rated as easy, 47% as moderately easy and 23% as difficult. Difficult intubations were associated with a higher incidence of anatomic anomalies, difficult bag-mask ventilation and severe oxygen desaturation. Every intubation in the ICU setting should be considered potentially difficult. The existing algorithm should be modified to incorporate the American Society of Anesthesiologists difficult airway algorithm adapted to the needs of the intensive care unit. A training program for alternative methods of airway management for difficult intubations should be established.