Some 40% of critically ill patients who have access to tracheal to support their breathing suffer from a life-threatening problem, according to a study from the National University of Scotland. Ireland Galway has appeared.
The study, published today in JAMA: Journal of the American Medical Association, involved 2,964 critically ill men and women. It was conducted across 29 countries from 1 October 2018 to 31 July 2019 to determine the risk of adverse events occurring from the aggressive method.
The study was co-authored by John Laffey, Professor of Intensive Care Medicine at NUI Galway and Consultant in Anesthesia and Intensive Care Medicine at Galway University Hospital.
“Placing a patient with a serious illness on an air conditioner is one of the most common types of life support we can offer someone in intensive care,” said Dr Laffey.
“But to provide this treatment clinicians need to perform tracheal intubation – an invasive procedure where a tube is inserted through the mouth into the windpipe.
“Better knowledge and understanding of the problems associated with this procedure is especially important as we address the impact of Covid-19. The pandemic is forcing us to treat physicians. doing a lot more of these methods and as usual and understanding the problems associated with them is the first step to finding ways to avoid them in the future, and hopefully the risk to them. reduce our patients. ”
Results from the INTUBE research study were presented by Professor Laffey at the Critical Care Association Conference.
Key findings included:
- 45.2% of patients experienced at least one life-threatening problem.
- Some 42.6% of patients suffered from severe cardiovascular instability.
- 272 patients, 9.3% of those in the study, suffered severe hypoxemia or very low oxygen levels.
- 93 patients, 3.1% of those in the study, suffered a heart attack.
- Patients at risk of hemodynamic instability had life-threatening complications prior to admission.
- Successful tracheal attachment on the first attempt of the procedure was associated with a lower risk of complications compared with repeated intubation attempts.
Dr Laffey said: “As clinicians we have little knowledge of tracheal intubation problems, how they affect our patients and how we can reduce the risk.
“Our research shows an incredibly high frequency of life-threatening complications associated with the procedure – with almost half of patients affected in this way. More importantly it shows that some of these problems could be prevented by different approaches and that we can improve outcomes for patients undergoing these high-risk procedures.
“Of particular concern is the fact that our research showed that patients suffering from intubation-related side effects were more likely to die either in the intensive care unit or within 28 days of the adverse event. . ”
Professor Tim O’Brien, Dean of the College of Medicine, Nursing and Health Sciences at NUI Galway, and Consultant Physician with Saolta University Healthcare Group, said: “Clinical research in intensive care units is challenging but extremely important. guiding clinical practice and is essential to improving survival rates. Such studies have a significant impact on clinical practice and indeed the relevance of this study is strengthened as a result of Covid. ”
Kevin Clarkson, Clinical Director for Critical and Perioperative Care at Saolta Hospital Group / Galway University Hospital, said: “This international observational study, which involved NUI Galway and Shaolta Hospital Group researchers, reinforces the continuing need to invest in postgraduates. training, equipping and imitation in this dangerous environment.
“The study sheds light on areas of use that need improvement and could lead to better patient outcomes. In particular, there are instruments to detect tracheal entry and the use of equipment to detect carbon dioxide. properly positioned breathing tube clear opportunities to reduce risk Opportunities at local University Hospital level, regional organizations and national training body programs are essential along with participation in such research to meet the real needs of patients from the onset of the serious illness. ”
Notes to editors
A copy of the paper can be obtained on the INTUBE study – Internal observation study to understand the impact and practices of BEst in airway management in critically ill patients – on request. Link to the paper on the Journal of the American Medical Association: https: /
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