title: Device and Medication Preferences of Canadian Physicians for Emergent Endotracheal Intubation in Critically Ill Patients.
abstract: OBJECTIVE
  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.
authors: *Department of Critical Care,Dalhousie University,Halifax,NS.
authors: Robert S
authors: RS
authors: Green
authors: ‡Clinical Epidemiology Program,Ottawa Hospital Research Institute,Ottawa,ON.
authors: Dean A
authors: DA
authors: Fergusson
authors: ¶CHU de Québec Research Center,Hôpital de l'Enfant-Jésus,Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine group).
authors: Alexis F
authors: AF
authors: Turgeon
authors: ‡Clinical Epidemiology Program,Ottawa Hospital Research Institute,Ottawa,ON.
authors: Lauralyn A
authors: LA
authors: McIntyre
authors: ‡‡Department of Emergency Medicine,Dalhousie University,Halifax,NS.
authors: George J
authors: GJ
authors: Kovacs
authors: §§Department of Anesthesia, Pharmacology and Therapeutics,University of British Columbia,Vancouver,BC.
authors: Donald E
authors: DE
authors: Griesdale
authors: ***Department of Internal Medicine,University of Manitoba,Winnipeg,MB.
authors: Ryan
authors: R
authors: Zarychanski
authors: *Department of Critical Care,Dalhousie University,Halifax,NS.
authors: Michael B
authors: MB
authors: Butler
authors: *Department of Critical Care,Dalhousie University,Halifax,NS.
authors: Nelofar
authors: N
authors: Kureshi
authors: †Trauma Nova Scotia,Halifax,NS.
authors: Mete
authors: M
authors: Erdogan
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D016638:Critical Illness / Q000628:therapy*; D004635:Emergency Medicine / Q000379:methods; D004867:Equipment Design; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D020704:Laryngoscopes; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
keywords: device; intubation; medication