Tracheal intubation in the critically ill patient

Area of Science:

• Critical Care Medicine
• Anesthesiology
• Emergency Medicine

Background:

• Tracheal intubation is a high-risk procedure in critical care, with 45% of patients experiencing adverse events.
• Cardiovascular instability (43%) is the most common event, followed by hypoxemia (9%) and cardiac arrest (3%).
• Critically ill patients face increased risks due to physiological derangements, making airway management 'physiologically difficult'.

Purpose of the Study:

• To review current evidence on tracheal intubation in critically ill patients.
• To understand peri-intubation risks and their impact on mortality.
• To evaluate interventions for preventing or mitigating adverse events during intubation.

Main Methods:

• Review of randomized studies on pre-oxygenation strategies.
• Analysis of evidence for positive pressure ventilation in hypoxemic patients.
• Examination of interventions to mitigate hemodynamic collapse post-intubation.

Main Results:

• Evidence supports pre-oxygenation and positive pressure ventilation for hypoxemic patients.
• Interventions to prevent hemodynamic collapse after intubation remain under-researched.
• Airway management in COVID-19 patients presents unique challenges due to infection risk.

Conclusions:

• Peri-intubation adverse events increase 28-day mortality risk.
• Further research is needed on strategies to mitigate hemodynamic instability during intubation.
• Optimizing airway management in critically ill patients, including those with COVID-19, is crucial.