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2015 ; 19
(1
): 258
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Endotracheal intubation in the ICU
#MMPMID26082175
Lapinsky SE
Crit Care
2015[Jun]; 19
(1
): 258
PMID26082175
show ga
Endotracheal intubation in the ICU is a high-risk procedure, resulting in
significant morbidity and mortality. Up to 40% of cases are associated with
marked hypoxemia or hypotension. The ICU patient is physiologically very
different from the usual patient who undergoes intubation in the operating room,
and different intubation techniques should be considered. The common operating
room practice of sedation and neuromuscular blockade to facilitate intubation may
carry significant risk in the ICU patient with a marked oxygenation abnormality,
particularly when performed by the non-expert. Preoxygenation is largely
ineffective in these patients and oxygen desaturation occurs rapidly on induction
of anesthesia, limiting the time available to secure the airway. The ICU
environment is less favorable for complex airway management than the operating
room, given the frequent lack of availability of additional equipment or
additional expert staff. ICU intubations are frequently carried out by trainees,
with a lesser degree of airway experience. Even in the presence of a
non-concerning airway assessment, these patients are optimally managed as a
difficult airway, utilizing an awake approach. Endotracheal intubation may be
achieved by awake direct laryngoscopy in the sick ICU patient whose level of
consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the
patient's spontaneous respiratory efforts are not depressed by the administration
of drugs, additional time is available to obtain equipment and expertise in the
event of failure to secure the airway. ICU intubation complications should be
tracked as part of the ICU quality improvement process.
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