Tracheal intubation in critically ill patients: A comprehensive systematic review of randomized trials

Luca Cabrini, Giovanni Landoni, Martina Baiardo Radaelli, Omar Saleh, Carmine D. Votta, Evgeny Fominskiy, Alessandro Putzu, Cézar Daniel Snak de Souza, Massimo Antonelli, Rinaldo Bellomo, Paolo Pelosi, Alberto Zangrillo

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. Methods: We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years. Exclusion criteria were pre-hospital or operating theatre settings and simulation-based studies. Two investigators selected studies for the final analysis. Extracted data included first author, publication year, characteristics of patients and clinical settings, intervention details, comparators and relevant outcomes. The risk of bias was assessed with the Cochrane Collaboration's Risk of Bias tool. Results: We identified 22 trials on use of a pre-procedure check-list (1 study), pre-oxygenation or apneic oxygenation (6 studies), sedatives (3 studies), neuromuscular blocking agents (1 study), patient positioning (1 study), video laryngoscopy (9 studies), and post-intubation lung recruitment (1 study). Pre-oxygenation with non-invasive ventilation (NIV) and/or high-flow nasal cannula (HFNC) showed a possible beneficial role. Post-intubation recruitment improved oxygenation, while ramped position increased the number of intubation attempts and thiopental had negative hemodynamic effects. No effect was found for use of a checklist, apneic oxygenation (on oxygenation and hemodynamics), videolaryngoscopy (on number and length of intubation attempts), sedatives and neuromuscular blockers (on hemodynamics). Finally, videolaryngoscopy was associated with severe adverse effects in multiple trials. Conclusions: The limited available evidence supports a beneficial role of pre-oxygenation with NIV and HFNC before intubation of critically ill patients. Recruitment maneuvers may increase post-intubation oxygenation. Ramped position increased the number of intubation attempts; thiopental had negative hemodynamic effects and videolaryngoscopy might favor adverse events.

Original languageEnglish
Article number6
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Jan 20 2018

Fingerprint

Intubation
Critical Illness
Hemodynamics
Neuromuscular Blocking Agents
Noninvasive Ventilation
Thiopental
Hypnotics and Sedatives
Patient Positioning
Laryngoscopy
Checklist
PubMed
Intensive Care Units
Publications
Hospital Emergency Service
Randomized Controlled Trials
Research Personnel
Clinical Trials
Safety
Equipment and Supplies
Lung

Keywords

  • Critically ill
  • Emergency department
  • High flow nasal cannula
  • Intensive care unit
  • Tracheal intubation
  • Videolaryngoscopy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Cabrini, L., Landoni, G., Baiardo Radaelli, M., Saleh, O., Votta, C. D., Fominskiy, E., ... Zangrillo, A. (2018). Tracheal intubation in critically ill patients: A comprehensive systematic review of randomized trials. Critical Care, 22(1), [6]. https://doi.org/10.1186/s13054-017-1927-3

Tracheal intubation in critically ill patients : A comprehensive systematic review of randomized trials. / Cabrini, Luca; Landoni, Giovanni; Baiardo Radaelli, Martina; Saleh, Omar; Votta, Carmine D.; Fominskiy, Evgeny; Putzu, Alessandro; Snak de Souza, Cézar Daniel; Antonelli, Massimo; Bellomo, Rinaldo; Pelosi, Paolo; Zangrillo, Alberto.

In: Critical Care, Vol. 22, No. 1, 6, 20.01.2018.

Research output: Contribution to journalArticle

Cabrini, L, Landoni, G, Baiardo Radaelli, M, Saleh, O, Votta, CD, Fominskiy, E, Putzu, A, Snak de Souza, CD, Antonelli, M, Bellomo, R, Pelosi, P & Zangrillo, A 2018, 'Tracheal intubation in critically ill patients: A comprehensive systematic review of randomized trials', Critical Care, vol. 22, no. 1, 6. https://doi.org/10.1186/s13054-017-1927-3
Cabrini L, Landoni G, Baiardo Radaelli M, Saleh O, Votta CD, Fominskiy E et al. Tracheal intubation in critically ill patients: A comprehensive systematic review of randomized trials. Critical Care. 2018 Jan 20;22(1). 6. https://doi.org/10.1186/s13054-017-1927-3
Cabrini, Luca ; Landoni, Giovanni ; Baiardo Radaelli, Martina ; Saleh, Omar ; Votta, Carmine D. ; Fominskiy, Evgeny ; Putzu, Alessandro ; Snak de Souza, Cézar Daniel ; Antonelli, Massimo ; Bellomo, Rinaldo ; Pelosi, Paolo ; Zangrillo, Alberto. / Tracheal intubation in critically ill patients : A comprehensive systematic review of randomized trials. In: Critical Care. 2018 ; Vol. 22, No. 1.
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