TY - JOUR
T1 - Device and Medication Preferences of Canadian Physicians for Emergent Endotracheal Intubation in Critically Ill Patients
AU - Green, Robert S.
AU - Fergusson, Dean A.
AU - Turgeon, Alexis F.
AU - McIntyre, Lauralyn A.
AU - Kovacs, George J.
AU - Griesdale, Donald E.
AU - Zarychanski, Ryan
AU - Butler, Michael B.
AU - Kureshi, Nelofar
AU - Erdogan, Mete
N1 - Publisher Copyright:
© 2016 Canadian Association of Emergency Physicians.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Objectives Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians. Methods A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from always to never to capture usual practice. Results The survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would always/often be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would always/often administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00). Conclusions Most EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.
AB - Objectives Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians. Methods A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from always to never to capture usual practice. Results The survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would always/often be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would always/often administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00). Conclusions Most EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.
UR - http://www.scopus.com/inward/record.url?scp=85019363779&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019363779&partnerID=8YFLogxK
U2 - 10.1017/cem.2016.361
DO - 10.1017/cem.2016.361
M3 - Article
C2 - 27573571
AN - SCOPUS:85019363779
SN - 1481-8035
VL - 19
SP - 186
EP - 197
JO - Canadian Journal of Emergency Medicine
JF - Canadian Journal of Emergency Medicine
IS - 3
ER -