Peter Luedike1, Matthias Totzeck2, Christos Rammos2, Detlef Kindgen-Milles3, Malte Kelm2, Tienush Rassaf2. 1. 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. 2. University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, D-40225 Düsseldorf, Germany. 3. University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Division of Anaesthesiology, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
Abstract
PURPOSE: 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. CONCLUSION: 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.
PURPOSE: 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. CONCLUSION: 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.