We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill.
We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years. Exclusion criteria were pre-hospital or operating theatre settings and simulation-based studies. Two investigators selected studies for the final analysis. Extracted data included first author, publication year, characteristics of patients and clinical settings, intervention details, comparators and relevant outcomes. The risk of bias was assessed with the Cochrane Collaboration’s Risk of Bias tool.
We identified 22 trials on use of a pre-procedure check-list (1 study), pre-oxygenation or apneic oxygenation (6 studies), sedatives (3 studies), neuromuscular blocking agents (1 study), patient positioning (1 study), video laryngoscopy (9 studies), and post-intubation lung recruitment (1 study). Pre-oxygenation with non-invasive ventilation (NIV) and/or high-flow nasal cannula (HFNC) showed a possible beneficial role. Post-intubation recruitment improved oxygenation, while ramped position increased the number of intubation attempts and thiopental had negative hemodynamic effects. No effect was found for use of a checklist, apneic oxygenation (on oxygenation and hemodynamics), videolaryngoscopy (on number and length of intubation attempts), sedatives and neuromuscular blockers (on hemodynamics). Finally, videolaryngoscopy was associated with severe adverse effects in multiple trials.
The limited available evidence supports a beneficial role of pre-oxygenation with NIV and HFNC before intubation of critically ill patients. Recruitment maneuvers may increase post-intubation oxygenation. Ramped position increased the number of intubation attempts; thiopental had negative hemodynamic effects and videolaryngoscopy might favor adverse events.
Additional file 1: Search strategy, flow chart of the systematic review, supplemental figures (forest plots). (DOCX 146 kb)13054_2017_1927_MOESM1_ESM.docx
Cook TM, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106:632–42. CrossRefPubMed
Mort TC. Emergency Tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99:607-613.
Janz DR, Semler MW, Joffe AM, Casey JD, Lentz RJ, deBoisblanc BP, et al. Check-UP Investigators; Pragmatic Critical Care Research Group. A multicenter randomized trial of a checklist for endotracheal intubation of critically ill adults. Chest. 2017;S0012–3692(17):32685–5
Jaber S, Monnin M, Girard M, Conseil M, Cisse M, Carr J, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42:1877–87. CrossRefPubMed
Sivilotti MLA, Ducharme J. Randomized, double-blind study on sedatives and hemodynamics during rapid-sequence intubation in the emergency department: the SHRED study. Ann Emerg Med. 1998;31:313–24. CrossRef
Pouraghaei M, Moharamzadeh P, Soleimanpour H, Rahmani F, Safari S, Mahmoodpoor A, et al. Comparison between the effects of alfentanil, fentanyl and sufentanil on hemodynamic indices during rapid sequence intubation in the emergency department. Anesthesiol Pain Med. 2014;4:e14618.
Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-hibon A, Vivien B, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2008;374:293–300. CrossRef
Semler MW, Janz DR, Russell DW, Casey JD, Lentz RJ, Zouk AN, et al. A Multicenter, randomized trial of ramped position versus sniffing position during endotracheal intubation of critically ill adults. Chest. 2017;152:712-722.
Griesdale DEG, Chau A, Isac G, Ayas N, Foster D, Irwin C, et al. Video-laryngoscopy versus direct laryngoscopy in critically ill patients: a pilot randomized trial. Can J Anaesth J Can Anesth. 2012;59:1032–9. CrossRef
Kim JW, Park SO, Lee KR, Hong DY, Baek KJ, Lee YH, et al. Video laryngoscopy vs. direct laryngoscopy: Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study of experienced intubators. Resuscitation. 2016;105:196–202. CrossRefPubMed
Lascarrou JB, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T, Mercier E, et al. video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients. JAMA. 2017;317:483-493.
Wong DT, Yee AJ, Leong SM, Chung F. The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review. Can J Anesth Can Anesth. 2017;64:416–27. CrossRef
Bruder EA, Ball IM, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. 2015;1:CD010225. PubMed
Keating GM. Sugammadex: a review of neuromuscular blockade reversal drugs, vol. 76. 2016. p. 1041–52.
Reynolds SF, Heffner J. Airway management of the critically ill patient. Chest. 2005;127:1397–412. PubMed
Zaidi G, Mayo PH. Urgent endotracheal intubation in the ICU: rapid sequence intubation versus graded sedation approach. In: Vincent J-L, editor. Annual Update Intensive Care Emerg Med 2017. Switzerland: Springer International Publishing; 2017. p. 255–62.
Zhao BC, Huang TY, Liu KX. Video laryngoscopy for ICU intubation: a meta-analysis of randomised trials. Intensive Care Med. 2017;43:947-948.
De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014;40:629–39. PubMed
- Tracheal intubation in critically ill patients: a comprehensive systematic review of randomized trials
Martina Baiardo Radaelli
Carmine D. Votta
Cézar Daniel Snak de Souza
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II