COMPARE THE FIRST SUCCESS OF INTUBATION BETWEEN INTUBATION WITHOUT THE SEDATIVE AGENT, SEDATIVE ONLY INTUBATION, AND RAPID SEQUENCE INTUBATION.
Article Sidebar
Main Article Content
Abstract
ฺ
BACKGROUND: Intubation is a critical lifesaving procedure to rescue airway. Intubation techniques were dependent on patient disease and physician experience.Each technique was difference in strength and weakness
OBJECTIVE: To study first attempt success rate of intubation between sedative only intubation, intubation without a sedative agent and rapid sequence intubation (RSI)
METHODS: The Efficacy research, non-randomized study, that recorded by information sheet. The patients who underwent emergency intubation at the Emergency room’s Phayao hospital during September 1st, 2020 – March 31st, 2021 were eligible for inclusion in the analyses divided into 3 groups: sedative only intubation 86 patients, intubation without a sedative agent 69 patients and RSI 28 patients, total 183 patients. The collected data was patient information, intubation technique, discipline, etc. to record and show percent of first attempt intubation success rate and complications. Analysis the data by Chi square test and two-way analysis of variance to compare the first attempt intubation success rate and complications, finally, Control for confounding by multivariable logistic regression.
RESULTS: Total patients meeting the criteria were 183 patients. The data about sex, age, shift, glottis level were not different in statistic. The data about causes, difficult airway and discipline were statistically different. The first attempt success rate of intubation between rapid sequence intubation, intubation without a sedative agent and sedative only intubation was significantly different (85.71%, 81.16% and 59.30% respectively, p=0.003). The data showed a significant difference in the status of the patients at post discharge from the emergency department (p <0.001). Multivariable logistic regression showed RSI has increased successful rate in first attempt intubation 1.61 times (95%CI 0.44 - 5.80 P-value 0.464), but Sedative-only intubation has decreased success rate 0.33 times. (95%CI 0.14 - 0.72, p=0.006)
CONCLUSIONS AND RECOMMENDATIONS: Rapid sequence intubation (RSI) was the best method for patient safety, quickly and with fewer complications, but more restriction. Other techniques seemed well-known and suitable for the general practitioner. This study will guide improvement & adaptation about technique and medical personnel.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Tintinalli JE,Ma OJ,Yealy D,Mecker G,Stapczynski J,Cline D,et al. Tintinalli's emergency medicine.9th ed. New York: McGraw-Hill Medical;2012.
American College of Surgeons. Committee Trauma. Advanced trauma life support: student course manual. 10th ed. Illinois: American College of Surgeons; 2018.
Boonsiri C, Sunthontum S. Corse workshop for advance resuscitative procedures. Thai College of Emergenct Physicians. Bangkok; 2020.
Rosen P, Marx JA, Hockberger RS, Walls RM. Rosen's emergency medicine: concepts and clinical practice. 6th ed. Missouri: Mosby; 2005.
Trakulsrichai S, Chalermdamrichai P, Palasatien I, Rattanasiri S, Chatchaipun P, Hathirat S. An Observation Study of Rapid Sequence, awake and sedation-only intubations in an emergency department in Thai patients. J Med Assoc Thai. 2009; 92(8): 022-7.
Merelman AH, Perlmutter MC, Strayer RJ. Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. West J Emerg Med. 2019;20(3):466-71
Sujinpram C. First-pass Intubation successful with rapid sequence intubation versus conventional endotracheal intubation in the emergency department. Medical journal of Srisaket Surin Buriram hospitals.2020;35(3):729-38.
Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84(11):1500-4.
De Jong A, Rolle A, Molinari N, Paugam-Burtz C, Constantin JM, Lefrant JY, et al. Cardiac arrest and mortality related to intubation procedure in critically ill adult patients: a multicenter cohort study. Crit Care Med. 2018;46(4):532-9.
Robert JR, Hedges J. Clinical Procedures in emergency medicine.6th ed. Pennsylvania: Elsevier Saunders;2014.
Chanthawong S, Chau-in W. Prospective study of tracheal intubation and immediate complications in the emergency room in Srinagarind Hospital. Srinagarind Med J.2015;30(3):256-61.
Hedigard S. The initial study of rapid sequence intubation (RSI) in the emergency room, Phrae Hospital. Journal of Phrae Hospital. 2011;19(1):103-14.
Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325-32.
Marin J, Davison D, Pourmand A. Emergent endotracheal intubation associated cardiac arrest, risks, and emergency implications. J Anesth. 2019;33(3):454-62.
