Urgent intubation without neuromuscular blocking agents and the risk of tracheostomy

Jun Fujinaga, Etsuji Suzuki, Akira Kuriyama, Mutsuo Onodera, Hiroyuki Doi

Research output: Contribution to journalArticle

Abstract

Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack–Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95% confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95% confidence interval 1.06–6.34, p value = 0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy.

Original languageEnglish
JournalInternal and Emergency Medicine
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Neuromuscular Blocking Agents
Tracheostomy
Intubation
Intensive Care Units
Logistic Models
Odds Ratio
Confidence Intervals
Incidence
Tertiary Healthcare
Tertiary Care Centers
Hospital Emergency Service
Japan
Emergencies
Cohort Studies
Retrospective Studies
Demography

Keywords

  • Airway management
  • Emergency patients
  • Neuromuscular blocking agents
  • Tracheostomy

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this

Urgent intubation without neuromuscular blocking agents and the risk of tracheostomy. / Fujinaga, Jun; Suzuki, Etsuji; Kuriyama, Akira; Onodera, Mutsuo; Doi, Hiroyuki.

In: Internal and Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

@article{73ecde528c5b42a8908b169ddd7bdc98,
title = "Urgent intubation without neuromuscular blocking agents and the risk of tracheostomy",
abstract = "Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack–Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95{\%} confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95{\%} confidence interval 1.06–6.34, p value = 0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy.",
keywords = "Airway management, Emergency patients, Neuromuscular blocking agents, Tracheostomy",
author = "Jun Fujinaga and Etsuji Suzuki and Akira Kuriyama and Mutsuo Onodera and Hiroyuki Doi",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11739-019-02214-0",
language = "English",
journal = "Internal and Emergency Medicine",
issn = "1828-0447",
publisher = "Springer-Verlag Italia",

}

TY - JOUR

T1 - Urgent intubation without neuromuscular blocking agents and the risk of tracheostomy

AU - Fujinaga, Jun

AU - Suzuki, Etsuji

AU - Kuriyama, Akira

AU - Onodera, Mutsuo

AU - Doi, Hiroyuki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack–Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95% confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95% confidence interval 1.06–6.34, p value = 0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy.

AB - Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack–Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95% confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95% confidence interval 1.06–6.34, p value = 0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy.

KW - Airway management

KW - Emergency patients

KW - Neuromuscular blocking agents

KW - Tracheostomy

UR - http://www.scopus.com/inward/record.url?scp=85074480242&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074480242&partnerID=8YFLogxK

U2 - 10.1007/s11739-019-02214-0

DO - 10.1007/s11739-019-02214-0

M3 - Article

AN - SCOPUS:85074480242

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

SN - 1828-0447

ER -