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Predictive Factors for First-Pass Intubation Failure in Trauma Patients.

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International Journal of General Medicine
|March 11, 2024
PubMed
Summary

Elevated systolic blood pressure is a key predictor of multiple intubation attempts in trauma patients. Critical appraisal of these patients may reduce risks during emergent tracheal intubation.

Keywords:
adultairwayemergency tracheal intubationfirst-pass intubation failureintubation traumamultiple intubation attemptstrauma

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Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Critical Care

Background:

  • Multiple intubation attempts (MIA) are associated with adverse outcomes in trauma patients.
  • Previous research identified anatomical risk factors for difficult airways, but predictors for MIA in trauma are less understood.

Purpose of the Study:

  • To identify risk factors for multiple intubation attempts (MIA) in trauma patients undergoing emergent tracheal intubation (ETI).
  • To assess secondary outcomes including mortality, ICU admission, and prolonged ventilation.

Main Methods:

  • Retrospective study of 174 adult trauma patients requiring ETI at a Level 1 Trauma Center (Jan 2019-Dec 2022).
  • Analysis of comorbidities, demographics, vitals, intubation characteristics, and outcomes.
  • Multivariate logistic regression used to identify independent predictors of MIA (p≤0.05).

Main Results:

  • 14.9% of patients required MIA.
  • No significant associations found between MIA and patient demographics, BMI, race, injury mechanism, or body region.
  • Elevated systolic blood pressure (SBP) was a significant univariate predictor of MIA (p=0.019).
  • Elevated SBP independently predicted MIA (aOR 1.03, 95% CI 1.01-1.06, p<0.015).

Conclusions:

  • Elevated systolic blood pressure is a significant predictor of multiple intubation attempts in trauma patients.
  • Targeted critical appraisal of trauma patients with elevated SBP may mitigate risks associated with multiple intubation attempts.