Effects of supervision by attending anesthesiologists on complications of emergency tracheal intubation.
BACKGROUND
Emergent intubation is associated with a high complication rate. These intubations are often performed by resident physicians in teaching hospitals. The authors evaluated whether supervision by an anesthesia-trained intensivist decreases complications of emergent intubations.


METHODS
The authors performed a prospective cohort study in an Academic Tertiary Care Hospital. They enrolled 322 consecutive patients who required emergent intubation between November 1, 2006, and April 15, 2008. Emergency intubations are performed by anesthesia residents during their surgical intensive care unit rotation. An attending anesthesiologist was assigned to supervise these intubations at predetermined periods. A respiratory therapist assisted with airway management and ventilation. Information related to the intubation, detailing patient demographics, indication for intubation, attending anesthesiologist presence, medications used, and immediate complications, was recorded. Disposition and duration of mechanical ventilation were also recorded.


RESULTS
There were no differences in demographics, clinical characteristics, or illness severity among patients intubated with and without attending supervision. Attending physician supervision was associated with a significant decrease in complications (6.1% vs. 21.7%; P = 0.0001). There was no difference in ventilator-free days or 30-day mortality.


CONCLUSIONS
Supervision by an attending anesthesiologist was associated with a decreased incidence of complications during emergent intubations.
Schmidt
Ulrich H
UH
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Gray 4, 55 Fruit Street, Boston, Massachusetts 02114, USA. uschmidt@partners.org
Kumwilaisak
Kanya
K
Bittner
Edward
E
George
Edward
E
Hess
Dean
D
D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology / Q000379:methods* / Q000592:standards; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D007431:Intraoperative Complications / Q000517:prevention & control*; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D009934:Organization and Administration / Q000592:standards; D011364:Professional Practice / Q000592:standards; D011446:Prospective Studies