Practice of Intubation of the Critically Ill at Mayo Clinic

Nathan Smischney, Mohamed O. Seisa, Katherine J. Heise, Kyle D. Busack, Theodore O. Loftsgard, Darrell R. Schroeder, Daniel A. Diedrich

1 Scopus citations

Abstract

Objective: To describe the practice of intubation of the critically ill at a single academic institution, Mayo Clinic’s campus in Rochester, Minnesota, and to report the incidence of immediate postintubation complications. Patients and Methods: Critically ill adult (≥18 years) patients admitted to a medical–surgical intensive care unit from January 1, 2013, to December 31, 2014, who required endotracheal intubation included. Results: The final cohort included 420 patients. The mean age at intubation was 62.9 ± 16.3 years, with 58% (244) of the cohort as male. The most common reason for intubation was respiratory failure (282 [67%]). The most common airway device used was video laryngoscopy (204 [49%]). Paralysis was used in 264 (63%) patients, with ketamine as the most common sedative (194 [46%]). The most common complication was hypotension (170 [41%]; 95% confidence interval [CI]: 35.7-45.3) followed by hypoxemia (74 [17.6%]; 95% CI: 14.1-21.6), with difficult intubation occurring in 20 (5%; 95% CI: 2.9-7.3). Conclusion: We found a high success rate of first-pass intubation in critically ill patients (89.8%), despite the procedure being done primarily by trainees 92.6% of the time; video was the preferred method of laryngoscopy (48.6%). Although our difficult intubation (4.8%) and complication rates typically associated with the act of intubation such as aspiration (1.2%; 95% CI: 0.4-2.8) and esophageal intubation (0.2%; 95% CI: 0.01-1.3) are very low compared to other published rates (8.09%), postintubation hypotension (40.5%) and hypoxemia (17.6%) higher.

Original languageEnglish (US)
Pages (from-to)204-211
Number of pages8
JournalJournal of Intensive Care Medicine
Volume34
Issue number3
DOIs
StatePublished - Mar 1 2019

Keywords

  • airway management
  • critically ill
  • intensive care unit
  • intubation
  • mayo clinic
  • outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Smischney, N., Seisa, M. O., Heise, K. J., Busack, K. D., Loftsgard, T. O., Schroeder, D. R., & Diedrich, D. A. (2019). Practice of Intubation of the Critically Ill at Mayo Clinic. Journal of Intensive Care Medicine, 34(3), 204-211. https://doi.org/10.1177/0885066617691495