Failed intubation occurs in about 1 in 390 patients, and maternal mortality is four times higher than in other populations. [2] Anatomical and physiological changes of pregnancy contribute to more rapid oxygen desaturation and a high risk of aspiration.
Level of intubator skill
Those studies with expert intubators reported a median intubation success rate of 0.994 (0.990–1.000).
Failed intubation is commonly caused by an incorrectly placed tube, which poses the risk of causing significant and broader complications for the patient. Thus, you should keep a high index of suspicion regarding tube placement — particularly in patients with difficult airways.
A number of intubation attempts may be undertaken - to change the blade (long, straight McCoy etc), to use the bougie or to apply optimal external laryngeal manipulation. After 3-4 attempts at intubation, it is likely that the practitioner is repeating fruitless attempts and no further attempts should be made.
REPEATED attempts at tracheal intubation increase the incidence of airway obstruction, leading to serious airway complications. Therefore, major guidelines for difficult airway management unanimously recommend avoiding repeated attempts at tracheal intubation.
The insertion procedure is brief — lasting only a few minutes. But you can stay intubated (with a breathing tube in place) for days or weeks depending on your medical needs.
When intubation error occurs, there can be several consequences for a patient. Brain, esophagus, nerve, vocal cord and lung damage may occur. After intubation, especially if the procedure is done improperly, a patient might suffer serious infections, bleeding, physical trauma or a collapsed lung.
The incidence of failed obstetric intubation is widely reported to be around 1:300. It has been suggested that failure rate may be associated with the frequency with which general anaesthesia is provided for Caesarean section within different institutions.
A likely indication of difficult intubation is present if the inter-incisor or hyoid-mental distance is less than three fingers or the hyoid-thyroid cartilage distance is less than two fingers.
Tracheal intubation may be difficult for either anatomical or physiological reasons. An anatomically difficult intubation (sometimes referred to as a “difficult airway”) involves challenges in viewing the vocal cords (difficult laryngoscopy) or passing a tube into the trachea (difficult endotracheal tube placement).
Accidental intubation of a bronchus is more common on the right because the right main bronchus is more vertically orientated than the left main bronchus.
[1] Proper positioning of any airway is vital for successful intubation, and it is important to know differences when compared to the adult patient.
Laryngeal injury – Laryngeal injury is the most common complication associated with ETT placement. It encompasses several disorders including laryngeal inflammation and edema as well as vocal cord ulceration, granulomas, paralysis, and laryngotracheal stenosis.
Out of those, 161 patients (70%) underwent CPR and only 4 survived. CFR defined as total number of intubated COVID-19 patients who underwent CPR and died (n= 157) divided by total number of intubated COVID-19 patients who underwent CPR (n=161) was calculated to be 97.5% (95% Cl: 95.1 – 99.92%).
In most cases, a person will fully recover from intubation within a few hours to days and will have no long-term side effects. People can ask the doctor or surgeon about all of the potential side effects and risks of intubation before surgery.
Tracheal intubation (TI) is a routine procedure in the intensive care unit (ICU), and is often life saving.
The optimal insertion tube depth for oral intubation is considered to be 20 cm for women and 22 cm for men (20/22 rule)4 or 21 cm for women and 23 cm for men (21/23 rule),2 depending on ethnicity. Such rough estimations, however, can lead to inadvertent endobronchial intubation or inadequate insertion.
A general approach is to stop CPR after 20 minutes if there is no ROSC or viable cardiac rhythm re-established, and no reversible factors present that would potentially alter outcome.
The “gold standard” (for now) of airway management has been trans-laryngeal endotracheal intubation. While it may be critically important that you learn how to perform the skills of intubation, knowing the sequence and tasks alone does not guarantee success.
Awake intubation was successfully performed with low failure rate (1%) and low complication rate (1.6%) under hemodynamically stable conditions. AWAKE intubation is the standard of care for management of the anticipated difficult airway in adult patients.
Most often patients are sleepy but conscious while they are on the ventilator—think of when your alarm clock goes off but you aren't yet fully awake.
Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency.
Intubation clearly saves lives, but intubation errors can have severe consequences for a patient. Damage to the brain, esophagus, nerves, vocal cord, and lungs can all occur when a breathing tube is improperly placed.
The breathing tube that is put into your airway can allow bacteria and viruses to enter your lungs and, as a result, cause pneumonia. Pneumonia is a major concern because people who need to be placed on ventilators are often already very sick. Pneumonia may make it harder to treat your other disease or condition.