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Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study

Emergency airway management outside the operating room (OR) is a higher risk procedure as compared to the OR setting. Inappropriate airway management leading to complications, including pulmonary aspiration, dental trauma, esophageal intubation, prolonged recovery, unplanned intensive care unit admi...

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Autores principales: Buasuk, Tarinee, Khongcheewinrungruang, Nalinpas, Suphathamwit, Aphichat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615514/
https://www.ncbi.nlm.nih.gov/pubmed/37904363
http://dx.doi.org/10.1097/MD.0000000000034907
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author Buasuk, Tarinee
Khongcheewinrungruang, Nalinpas
Suphathamwit, Aphichat
author_facet Buasuk, Tarinee
Khongcheewinrungruang, Nalinpas
Suphathamwit, Aphichat
author_sort Buasuk, Tarinee
collection PubMed
description Emergency airway management outside the operating room (OR) is a higher risk procedure as compared to the OR setting. Inappropriate airway management leading to complications, including pulmonary aspiration, dental trauma, esophageal intubation, prolonged recovery, unplanned intensive care unit admission and death. The emergency difficult airway management team of Siriraj hospital has been established since 2018 under the name of Code-D delta. The aim of this study is to determine the rate of Code D-delta activation, the performance of the code, the complications and outcome of the patients. This is a single-centered, observational, and retrospective study included all adult patient who was emergency intubated outside the OR between July and November 2020. The criteria for code D-delta activation included failed intubation for more than 2 attempts and suspected difficult intubation. The collected data were categorized into Code D-delta activation and non-activation group. The primary outcome was a frequency of Code D-delta activation. The demographic data, ward and indication of activation, intubation process, the complications of intubation were also collected and analyzed. During the study period, 247 patients with 307 intubations were included. The incidence of code D-delta activation was 8.14%. Regarding indication of activation, failed intubation more than 2 attempts was 40%, while suspected difficult intubation was 92%. Respiratory failure was the highest main diagnosis at 36%. The highest rate of activation was from medicine ward (60%), followed by surgery ward (16%) and emergency department (16%). Regarding the code responses and intubation performance, 7 and 10 minutes were the median time from call to scene in- and out- of official hours. The success rate of intubation at scene by code D-delta team was 85%. The airway and other complications were comparable between groups. This is the first study about emergency difficult airway management team in university hospital of Thailand. This study showed the rate of Code-D delta activation, the emergency airway management code, was 8.14% with the success rate of 85% at scene. Emergency airway management outside the operating room is particularly challenging. Airway assessment, planning, decision making of the team relevant to the patients outcomes.
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spelling pubmed-106155142023-10-31 Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study Buasuk, Tarinee Khongcheewinrungruang, Nalinpas Suphathamwit, Aphichat Medicine (Baltimore) 3300 Emergency airway management outside the operating room (OR) is a higher risk procedure as compared to the OR setting. Inappropriate airway management leading to complications, including pulmonary aspiration, dental trauma, esophageal intubation, prolonged recovery, unplanned intensive care unit admission and death. The emergency difficult airway management team of Siriraj hospital has been established since 2018 under the name of Code-D delta. The aim of this study is to determine the rate of Code D-delta activation, the performance of the code, the complications and outcome of the patients. This is a single-centered, observational, and retrospective study included all adult patient who was emergency intubated outside the OR between July and November 2020. The criteria for code D-delta activation included failed intubation for more than 2 attempts and suspected difficult intubation. The collected data were categorized into Code D-delta activation and non-activation group. The primary outcome was a frequency of Code D-delta activation. The demographic data, ward and indication of activation, intubation process, the complications of intubation were also collected and analyzed. During the study period, 247 patients with 307 intubations were included. The incidence of code D-delta activation was 8.14%. Regarding indication of activation, failed intubation more than 2 attempts was 40%, while suspected difficult intubation was 92%. Respiratory failure was the highest main diagnosis at 36%. The highest rate of activation was from medicine ward (60%), followed by surgery ward (16%) and emergency department (16%). Regarding the code responses and intubation performance, 7 and 10 minutes were the median time from call to scene in- and out- of official hours. The success rate of intubation at scene by code D-delta team was 85%. The airway and other complications were comparable between groups. This is the first study about emergency difficult airway management team in university hospital of Thailand. This study showed the rate of Code-D delta activation, the emergency airway management code, was 8.14% with the success rate of 85% at scene. Emergency airway management outside the operating room is particularly challenging. Airway assessment, planning, decision making of the team relevant to the patients outcomes. Lippincott Williams & Wilkins 2023-10-27 /pmc/articles/PMC10615514/ /pubmed/37904363 http://dx.doi.org/10.1097/MD.0000000000034907 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) (https://creativecommons.org/licenses/by-nc/4.0/) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
spellingShingle 3300
Buasuk, Tarinee
Khongcheewinrungruang, Nalinpas
Suphathamwit, Aphichat
Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study
title Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study
title_full Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study
title_fullStr Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study
title_full_unstemmed Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study
title_short Difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of Thailand: A single-center retrospective observational study
title_sort difficult airway code activation for emergency endotracheal intubation outside the operating room in a tertiary care university hospital of thailand: a single-center retrospective observational study
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615514/
https://www.ncbi.nlm.nih.gov/pubmed/37904363
http://dx.doi.org/10.1097/MD.0000000000034907
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