title: The MACOCHA score is feasible to predict intubation failure of nonanesthesiologist intensive care unit trainees.
abstract: OBJECTIVE
  Endotracheal intubation (ET) in intensive care unit (ICU) patients is regarded as more challenging than elective intubations in the operating room. Despite challenging conditions in ICU, trainees are often the initial operators performing ET. Because nonanesthesiologist intensivists with limited experience in ET run most of the nonsurgical ICUs, it is of exceptional importance to identify patients with predictable difficult ET in advance to prepare for a difficult airway scenario and thus avoid severe complications.
  
  
  METHODS
  In this prospective, observational, single-center study, we used a truncated MACOCHA score to evaluate intubation performance of nonanesthesiologist ICU trainees in an interdisciplinary medical ICU.
  
  
  RESULTS
  We show that (a) ET could be performed safely and without fatal complications in all cases; (b) the MACOCHA score is feasible on a nonanesthesiologist ICU; (c) a truncated MACOCHA score of at least 8 predicts failure of ICU trainees; and (d) availability of an ear, nose, and throat physician and an anesthesiologist is required to warrant successful management of difficult airways.
  
  
  CONCLUSIONS
  Our findings are a further step to implement the MACOCHA score into the standard admission procedure of an ICU to identify early those patients in whom additional support is needed in case of ET and to improve patient safety.
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, D-40225 Düsseldorf, Germany. Electronic address: Peter.Luedike@med.uni-duesseldorf.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Luedike
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Totzeck
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Rammos
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Anaesthesiology, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Kindgen-Milles
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
authors.forename: Tienush
authors.initials: T
authors.lastname: Rassaf
mesh_terms: D000368:Aged; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards*; D008297:Male; D009873:Operating Rooms; D061214:Patient Safety; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D017211:Treatment Failure
keywords: ICU; Intubation; MACOCHA; Nonanesthesiologist; Trainee