Survey on the Current State of Endotracheal Intubation Among the Critically Ill: HEMAIR Investigators.
OBJECTIVE
In the last decade, the practice of intubation in the intensive care unit (ICU) has evolved. To further examine the current intubation practice in the ICU, we administered a survey to critical care physicians.


METHODS
Cross-sectional survey study design.


METHODS
Thirty-two academic/nonacademic centers nationally and internationally.


RESULTS
The survey was developed among a core group of physicians with the assistance of the Survey Research Center at Mayo Clinic, Rochester, Minnesota. The survey was pilot tested for functionality and reliability. The response rate was 82 (51%) of 160 among the 32 centers. Although propofol was the induction drug of choice, there was a significant difference with actual ketamine use and those who indicated a preference for it (ketamine: 52% vs 61%; P < .001). The most common airway device used for intubation was direct laryngoscopy (Miller laryngoscope blade) at 56 (68%) followed by video laryngoscopy at 26 (32%). Most (>90%) indicated that they have a difficult airway cart, but only 55 (67%) indicated they have a documented plan to handle a difficult airway with even lower results for documented review of adverse events (49%).


CONCLUSIONS
Although propofol was the induction drug of choice, ketamine was a medication that many preferred to use, possibly relating to the fact that the most common complication postintubation is hypotension. Direct laryngoscopy remains the primary airway device for endotracheal intubation. Finally, although the majority stated they had a difficult airway cart available, most did not have a documented plan in place when encountering a difficult airway or a documented process to review adverse events surrounding intubation.
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.|2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
Mohamed O
MO
Seisa
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.|2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
Venkatesh
V
Gondhi
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
Onur
O
Demirci
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.|2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
Daniel A
DA
Diedrich
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.|2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
Rahul
R
Kashyap
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.|2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
Nathan J
NJ
Smischney
D018686:Anesthetics, Intravenous; D016638:Critical Illness; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D007442:Intubation, Intratracheal / Q000592:standards*; D007828:Laryngoscopy / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'
D018686:Anesthetics, Intravenous
airway management; endotracheal intubation; hemodynamic management; intensive care unit; survey