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Burlington, MA, United States

Elmer J.,University of Pittsburgh | Lee S.,University of Pittsburgh | Rittenberger J.C.,University of Pittsburgh | Dargin J.,Lahey Medical Center and Hospital | And 2 more authors.
Critical Care | Year: 2015

Introduction: In critically ill patients, re-intubation is common and may be a high-risk procedure. Anticipating a difficult airway and identifying high-risk patients can allow time for life-saving preparation. Unfortunately, prospective studies have not compared the difficulty or complication rates associated with reintubation in this population. Methods: We performed a secondary analysis of a prospective registry of in-hospital emergency airway management, focusing on patients that underwent multiple out-of-operating room intubations during a single hospitalization. Our main outcomes of interest were technical difficulty of intubation (number of attempts, need for adjuncts to direct laryngoscopy, best Cormack-Lehane grade and training level of final intubator) and the frequency of procedural complications (aspiration, arrhythmia, airway trauma, new hypotension, new hypoxia, esophageal intubation and cardiac arrest). We compared the cohort of reintubated patients to a matched cohort of singly intubated patients and compared each repeatedly intubated patient's first and last intubation. Results: Our registry included 1053 patients, of which 151 patients (14%) were repeatedly intubated (median two per patient). Complications were significantly more common during last intubation compared to first (13% versus 5%, P = 0.02). The most common complications were hypotension (41%) and hypoxia (35%). These occurred despite no difference in any measure of technical difficultly across intubations. Conclusion: In this cohort of reintubated patients, clinically important procedural complications were significantly more common on last intubation compared to first. © 2015 Elmer et al. Source

Craven D.E.,Center for Infectious Diseases and Prevention | Craven D.E.,Tufts University | Hudcova J.,Tufts University | Hudcova J.,The Surgical Center | And 3 more authors.
Critical Care | Year: 2014

Nseir and colleagues presented data from a large multicenter study of patients with ventilator-associated tracheobronchitis (VAT), demonstrating that appropriate antibiotic therapy for VAT was an independent predictor for reducing transition to pneumonia (ventilator-associated pneumonia, or VAP). These data added to the growing evidence supporting the use of appropriate antibiotic therapy for VAT as a standard of care to prevent VAP and improve patient outcomes. © 2014 Craven et al.; licensee BioMed Central Ltd. Source

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