An audit of airway management in critically ill patients in a sub-Saharan tertiary hospital

Abstract

Critically ill patients have poor physiological reserves, and are at increased risk of cardiopulmonary complications such as hypoxia, hypotension, arrhythmias and cardiac arrest when undergoing airway management. This study audited airway management in critically ill patients. Patients Method: A Prospective observational study in 120 critically ill adult patients who required endotracheal intubation over a one year period. Induction was with IV midazolam (0.15mg/kg), and suxamethonium (1.5mg/kg). Data collected included immediate complications (complications during intubation), and early complications (complications on days one to seven of tube insertion). Results: The median age was 32 years, males constituted 68 (56.6%) and female 52 (43.4%). One hundred and fifty-eight intubation attempts were recorded, one attempt to success in 93 (77.5%), and 2 attempts in 22 (18.33%). Difficult intubation occurred in 17 (10.49%), of whom 5 subjects had more than 3 intubation attempts, and 2 had surgical tracheostomy performed. The intubation aids used included stylet in 86.67%, bougie (3.33%), and laryngeal mask airway (1.67%). There was a significant association between the number of attempts at intubation, and trauma, bleeding, oesophageal intubation, aspiration or cardiac arrest, P<0.05. Tubal blockade occurred in 65 (36.31%) subjects after a median duration of 38.5 hours. Conclusion: This study elicited the need to review the airway management of critically ill patients in our institution, provide different airway and intubating devices during difficult intubation, and ensure appropriate training in airway skills.

Keywords

• Airway management
• complications
• critically ill