title: Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications.
abstract: The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas >1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p < 0.001) of those requiring more than one attempt. Logistic regression analysis shows that >1 attempt is associated with 6.4 (95 % CI 4.4-9.3) times the adjusted odds of at least one complication. Pre-intubation predictors of at least one complication despite first attempt success include vomit or edema in the airway as well as the presence of hypoxemia or hypotension. There are increased odds of complications with even a second attempt at intubation in the Intensive Care Unit. Complications occur frequently despite a successful first attempt, and as such, the goal of airway management should not be simply first attempt success, but instead first attempt success without complications.
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.|Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, FOB 122C, Tucson, AZ, 85724, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Hypes
authors.affiliation: Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, FOB 122C, Tucson, AZ, 85724, USA.
authors.forename: John
authors.initials: J
authors.lastname: Sakles
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.|Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, FOB 122C, Tucson, AZ, 85724, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.|Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, FOB 122C, Tucson, AZ, 85724, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Greenberg
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Natt
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Malo
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
authors.forename: John
authors.initials: J
authors.lastname: Bloom
authors.affiliation: University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
authors.forename: Harsharon
authors.initials: H
authors.lastname: Chopra
authors.affiliation: Section of Pulmonary, Allergy, Critical Care, and Sleep, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA. jmosier@aemrc.arizona.edu.|Department of Emergency Medicine, University of Arizona, 1609 N. Warren Ave, FOB 122C, Tucson, AZ, 85724, USA. jmosier@aemrc.arizona.edu.
authors.forename: Jarrod
authors.initials: J
authors.lastname: Mosier
mesh_terms: D000368:Aged; D058109:Airway Management / Q000592:standards; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000592:standards* / Q000706:statistics & numerical data; D007828:Laryngoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000592:standards*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000150:complications
keywords: Airway management; Artificial; Intensive care units; Intratracheal; Intubation; Laryngoscopy; Respiration