Although nearly all intubations were successful, many patients experienced postintubation hypoxia and hypotension.

To characterize intubation practice in Scotland, researchers conducted a 4-month prospective observational study of urgent and emergent intubations performed outside the operating room and in the absence of cardiopulmonary resuscitation. Critical care physicians at 22 of the nation's 24 adult intensive care units (ICUs) recorded data on a standardized form for 2260 ICU patients who were intubated during their hospital stay; complete data were available for 710 patients (mean age, 54).


Most intubations occurred in ICUs (70%) and emergency departments (18%). Overall, 91% of tracheal intubations were successful on the first attempt. Difficult airway predictors (obesity, cervical spine immobilization, grade 3 or 4 Mallampati view, reduced mouth opening or thyromental distance) were present in 28% of patients. Nine percent of patients with difficult airway predictors and 6% of patients without predictors had Cormack and Lehane grade 3 or 4 glottic views. Before intubation, 39% of patients were hypoxic (SpO2 <90%), 23% of patients were receiving noninvasive ventilation, 20% were hypotensive (systolic blood pressure <90 mm Hg), and 15% required vasopressor support. After intubation, 22% of patients were severely hypoxemic (SpO2 <80%) and 20% were severely hypotensive (SBP <80 mm Hg); corresponding preintubation percentages were 11% and 6%.


Citation(s):

Simpson GD et al. Tracheal intubation in the critically ill: A multi-centre national study of practice and complications. Br J Anaesth 2012 May; 108:792.