Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey
Introduction: Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2016-09-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/3t00r076 |
| _version_ | 1818152018866339840 |
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| author | Robert S. Green Dean A. Fergusson Alexis F. Turgeon Lauralyn A. McIntyre George J. Kovacs Donald E. Griesdale Ryan Zarychanski Michael B. Butler Nelofar Kureshi Mete Erdogan |
| author_facet | Robert S. Green Dean A. Fergusson Alexis F. Turgeon Lauralyn A. McIntyre George J. Kovacs Donald E. Griesdale Ryan Zarychanski Michael B. Butler Nelofar Kureshi Mete Erdogan |
| author_sort | Robert S. Green |
| collection | DOAJ |
| description | Introduction: Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI.
Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure), we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients.
Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758). Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203) of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830). Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%), pneumonia (EM 97%; CCM 95%) and trauma (EM 96%; CCM 96%). Pre-EETI resuscitation using vasopressors was uncommon (4.9%). Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001).
Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation. |
| first_indexed | 2024-12-11T13:48:03Z |
| format | Article |
| id | doaj.art-097ad1d462db4f96bfae299b2e6ddc3b |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-11T13:48:03Z |
| publishDate | 2016-09-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-097ad1d462db4f96bfae299b2e6ddc3b2022-12-22T01:04:23ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182016-09-0117554254810.5811/westjem.2016.6.30503Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National SurveyRobert S. Green0Dean A. Fergusson1Alexis F. Turgeon2Lauralyn A. McIntyre3George J. Kovacs4Donald E. Griesdale5Ryan Zarychanski6Michael B. Butler7Nelofar Kureshi8Mete Erdogan9Dalhousie University, Department of Critical Care, Halifax, Nova Scotia, Canada; Trauma Nova Scotia, Halifax, Nova Scotia, CanadaUniversity of Ottawa, Department of Medicine, Division of Clinical Epidemiology, Ottawa, Ontario, Canada; University of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, CanadaUniversité Laval, CHU de Quebec Research Center, Hôpital de l’Enfant-Jesus, Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine Group, Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Quebec City, Quebec, CanadaUniversity of Ottawa, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; University of Ottawa, Department of Medicine, Division of Critical Care Medicine, Ottawa, Ontario, CanadaDalhousie University, Department of Emergency Medicine, Halifax, Nova Scotia, CanadaUniversity of British Columbia, Department of Anesthesia, Pharmacology and Therapeutics, Vancouver, Department of Medicine, Division of Critical Care, Vancouver, British Columbia, Canada; Vancouver Coastal Health Research Institute, Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, CanadaCancerCare Manitoba, Department of Haematology and Medical Oncology, Winnipeg, Manitoba, Canada; University of Manitoba, Winnipeg Regional Health Authority, George & Fay Yee Center for Healthcare Innovation, Department of Internal Medicine, Winnipeg, Manitoba, CanadaDalhousie University, Department of Critical Care, Halifax, Nova Scotia, CanadaDalhousie University, Department of Critical Care, Halifax, Nova Scotia, CanadaTrauma Nova Scotia, Halifax, Nova Scotia, CanadaIntroduction: Respiratory failure is a common problem in emergency medicine (EM) and critical care medicine (CCM). However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI). Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure), we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients. Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758). Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203) of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830). Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%), pneumonia (EM 97%; CCM 95%) and trauma (EM 96%; CCM 96%). Pre-EETI resuscitation using vasopressors was uncommon (4.9%). Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001). Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.http://escholarship.org/uc/item/3t00r076ResuscitationIntubation |
| spellingShingle | Robert S. Green Dean A. Fergusson Alexis F. Turgeon Lauralyn A. McIntyre George J. Kovacs Donald E. Griesdale Ryan Zarychanski Michael B. Butler Nelofar Kureshi Mete Erdogan Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey Western Journal of Emergency Medicine Resuscitation Intubation |
| title | Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey |
| title_full | Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey |
| title_fullStr | Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey |
| title_full_unstemmed | Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey |
| title_short | Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey |
| title_sort | resuscitation prior to emergency endotracheal intubation results of a national survey |
| topic | Resuscitation Intubation |
| url | http://escholarship.org/uc/item/3t00r076 |
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