Aspiration during Rapid Sequence Induction: Prevalence and Risk Factors

Area of Science:

• Emergency Medicine
• Critical Care
• Pulmonology

Background:

• Securing a definitive airway is challenging in emergency departments (ED) for patients with compromised airways.
• Rapid sequence induction (RSI) is a common procedure for intubation in the ED.

Purpose of the Study:

• To determine the prevalence and risk factors for aspiration pneumonia (AP) in adult patients undergoing RSI in the ED.
• To evaluate the utility of endotracheal tube (ET) aspirate pepsin assay in diagnosing AP.

Main Methods:

• Prospective observational study conducted from September 2019 to March 2020.
• Recruited adult patients requiring RSI in the ED.
• Analyzed demographic data, intubation success rates, adverse events, and AP development.

Main Results:

• 154 patients underwent RSI; 13.4% developed AP.
• Male gender (AOR: 7.29) and diabetes mellitus (AOR: 3.75) were independent risk factors for AP.
• First attempt success rate was 76.7%; 21.4% experienced immediate adverse events.
• ET aspirate pepsin assay showed low sensitivity (44.44%) and specificity (73.53%) for AP prediction.

Conclusions:

• Male gender and diabetes mellitus are significant predictors of AP risk following ED RSI.
• ET aspirate pepsin levels are unreliable for diagnosing AP in this setting.