Endotracheal Intubation
Conditions
Brief summary
Describing characteristics of the practice of airway management in Dutch emergency departments, including information about patient demographics, indications, performer characteristics, equipment and medication used and complications due to intubation.
Detailed description
Endotracheal intubation can be a lifesaving intervention for critically ill patients in the emergency department (ED). Endotracheal intubation is, however, a high-risk procedure with many potential complications, which seem to be even more prevalent when carried out in the ED compared to for example the operating theater. This is possibly due to multiple reasons such as a sicker population, non-elective setting, a higher variability among indications for intubation or competence of providers. Internationally, large registries were established and multiple observational studies have been performed to gain more information about the methods, safety and complications of intubations in the ED. While in recent years these studies have added to our knowledge of ED airway management, there is still a lack of high-quality studies and there is a strong argument for increased research. To date, no studies have been published of airway management in Dutch EDs. The investigators therefore have no knowledge about any factors possibly influencing intubation outcomes and complications nor comparability with international data. Among these are factors that have been associated with preventable harm and death and insight into these factors could be used for improvement of the safety of airway management in Dutch EDs. This study is therefore intended to provide a comprehensive review of the clinical practice and characteristics of endotracheal intubations within Dutch EDs. The results could potentially be used for comparative analysis against global datasets. Additionally, the insights gained from this study will shed light on existing gaps prevalent in the current registration processes of intubations in the Netherlands. Furthermore, these insights could act as a stepping stone for future investigations that can lead to a deeper understanding of the methodologies, safety protocols, and associated complications of endotracheal intubations within Dutch EDs
Interventions
PROCEDUREEndotracheal intubation
All endotracheal intubations carried out in the emergency department of one of the participating hospitals in the time period 01-01-2019 - 31-12-2023
Sponsors
VieCuri Medical Centre
Catharina Ziekenhuis Eindhoven
Rijnstate Hospital
Zuyderland Medical Centre
Frisius Medisch Centrum
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* All patients who underwent endotracheal intubation between 01-01-2019 and 31-12-2023 in the participating ED's
Exclusion criteria
* Patients for which no information about the intubation can be found in the electronic patient chart will be excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Different complications of endotracheal intubation | At the time of intervention and consequent 1 hour | * significant decrease of SpO2. Defined as: desaturation of \>10% from baseline or as defined by the treating physician * significant decrease of blood pressure. Defined as: systolic pressure \<90mmHg with a drop of \>20% from baseline or as defined by the treating physician. * significant increase of blood pressure. Defined as: systolic pressure \> 160mmHg with a rise of \>20% from baseline, or as defined by the treating physician. * significant bradycardia. Defined as: heart rate \< 40/min and a drop of \> 20% from baseline, or as defined by the treating physician. * significant tachycardia. Defined as: heart rate \> 160/min and a rise of \> 20% from baseline, or as defined by the treating physician. * dental or airway trauma * oesophageal or mainstem bronchial intubation * vomiting or aspiration * laryngospasm * equipment failure * medication error * cardiac arrest * failed attempt / need for an emergency surgical airway * other |
Other
| Measure | Time frame | Description |
|---|---|---|
| Indication for intubation | At the time of intervention and consequent 1 hour | Indications could be: Trauma Burns Drowning Overdose/ingestion Respiratory failure Cardiac arrest (active cardiac arrest) Post-cardiac arrest Stroke Seizure Altered mental status due to other cause (if altered mental status due to stroke, intoxication, seizure or post-cardiac arrest then score as the primary cause) Sepsis Cardiac failure Airway obstruction GI bleed Anaphylaxis Other |
| Sedation agent used | At the time of intervention and consequent 1 hour | Ketamine, etomidate, propofol, midazolam |
| Paralytic agent used | At the time of intervention and consequent 1 hour | Rocuronium / Succinylcholine |
| Intubator characteristics | At the time of intervention and consequent 1 hour | Specialty and function/seniority of the intubator |
| Method of intubation | At the time of intervention and consequent 1 hour | Direct laryngoscopy Video (hyperangulated or direct) Fiberoptic Surgical airway |
| Patient characteristics | At the time of intervention and consequent 1 hour | Demographics of the patient who underwent endotracheal intubation. Such as age (years), gender (male/female), weight/obesity (BMI) |
| Sedative agent after intubation | At the time of intervention and consequent 1 hour | Propofol Fentanyl Midazolam Morphine Ketamine Other Not indicated |
Countries
Netherlands
Contacts
Primary ContactPeter Veldhuis, MD
Outcome results
None listed