Reducing complications related to endotracheal intubation in critically ill patients

Excerpt

Jaber and colleagues recently described a 10-point intervention aimed at reducing complications associated with endotracheal intubation and demonstrated a reduction in life-threatening events, such as severe hypoxaemia and circulatory collapse, occurring in the first hour following intubation [1]. Although these outcomes are commendable, we suggest that this intubation bundle or checklist could be improved by the inclusion of preparatory elements in the pre-intubation phase of the bundle. Difficult airway evaluation and the organisation of equipment, such as working suction, appropriate laryngoscopes, oropharyngeal airways and endotracheal tubes, is a prerequisite in all patients [2]. Most of this essential equipment can be pre-assembled in intubation packs, which could include a checklist in order to save time. The authors suggest that standard operating procedures for intubation are employed in the operating room but are lacking in intensive care units (ICU). Common, standard operating procedures for intubation in both environments are likely to reduce opportunities for error; however, some aspects of this procedure, such as patient positioning, may be different in the ICU. …