Adherence to Evidence-Base Endotracheal Intubation Practice Patterns by Intensivists and Emergency Department...

Area of Science:

• Critical Care Medicine
• Emergency Medicine
• Airway Management

Background:

• Endotracheal intubation outside the operating room (OR) is a critical procedure primarily performed by intensive care (IC) and emergency department (ED) physicians.
• Existing literature suggests potential variations in practice patterns between these two specialist groups during out-of-OR intubations.

Purpose of the Study:

• To investigate and compare the practice patterns of IC physicians and ED physicians during endotracheal intubation performed outside the operating room.
• To identify differences in the utilization of specific airway management tools and techniques between IC and ED physicians.

Main Methods:

• A retrospective chart review of all endotracheal intubations conducted outside the OR over a five-year period at a single healthcare facility.
• Comparison of practice patterns between IC and ED physicians concerning the use of video laryngoscopy, paralytic agents, waveform capnography, and endotracheal tube size (internal diameter ≥ 8 mm).

Main Results:

• Intensive care physicians demonstrated higher utilization of video laryngoscopy (67% vs. 49%), waveform capnography (99% vs. 86%), and larger endotracheal tubes (95% vs. 60%) compared to ED physicians.
• Conversely, paralytic agents were used less frequently by IC physicians (12% vs. 51%).
• The success rate of the first intubation attempt was significantly higher for IC physicians (82% vs. 67%).

Conclusions:

• Intensive care physicians exhibited greater adherence to preferred practices for endotracheal intubation compared to ED physicians in this single-center study.
• Identified practice variations highlight opportunities to bridge gaps and potentially improve patient outcomes in out-of-OR airway management.
• Further large-scale studies are warranted to elucidate the impact of these differing practice patterns on short- and long-term patient outcomes.