Attempts at Emergent Tracheal Intubation of Inpatients: A Retrospective Practice Analysis Comparing Adjunct Sedation With or Without Neuromuscular Blockade

Abstract

As part of emergency airway management, anesthesia personnel are frequently responsible for the emergent tracheal intubation of inpatients. The purpose of this retrospective analysis was to examine the number of attempts necessary for a successful emergent inpatient tracheal intubation. All intubation attempts had utilized adjunct sedation. Patient age, gender, and the use of neuromuscular blockade (NMB) were also investigated. Overall, 73.1% of all intubations, were reported as successful, having used only adjunct sedation and without the use of NMB (P<0.001). This was regardless of the number of attempts reported for each intubation. Furthermore, 54.9% of all intubations had been reported as successful, on the first attempt, without NMB (P<0.001). An association, between tracheal intubation attempts and the use of NMB, had also been retrospectively observed. NMB, when used, was found to have been associated with a greater number of intubation attempts (P<0.0001). NMB was also noted to have been used more often with younger inpatients (P<0.001) and males (P<0.01). The probability, of a successful emergent inpatient tracheal intubation attempt, was found to have been associated with only NMB use (P<0.001). This was accomplished using a logistic regression model. Using this model, neither age nor gender were determined to have been factors for multiple intubation attempts. Based on this retrospective analysis, it appears that NMB does not need to be used, on a routine basis, for emergent inpatient tracheal intubations.