Out of Intensive Care and Operating Theatre Intubations: Prospective Observational Study

Abstract

Tracheal intubations are not infrequent out of ICUs and operating theatres and carry a substantial risk of adverse events. Our objective was t o study the current practices of tracheal intubations in medical wards of the national hospital of Sri Lanka (NHSL). A prospective observational study was performed among all adult patients who had an endotracheal intubation in a medical ward of NHSL over a 6-month period. There were 47 intubations. Majority, 29 (61.7%) of intubations occurred during out of hours (after 4pm) and 23 (48.9%) of them were emergency intubations. Most common reason for intubation was respiratory distress 26 (55.3%). Other indications were cardiac arrest 11 (23.4%), Low GCS 7 (14.9%) and shock 2 (4.3%). Capnography and 2 laryngoscopes were not available during any of the intubations. Bougie was available only in 23 (48.9%) cases and alternative airway equipment were available only in 9 (19.1) cases. Midazolam was the most common induction agent 34 (72.3%). Majority 27(57.4%) of the intubators had less than 6 months of experience in anaesthesia. Most of the intubations 32 (68.1%) were done by a registrar and 6 (12.8%) were done by an intern medical officer. There were 39 adverse events during all intubations and hypotension 14(29.8%) was the most frequent adverse event. Therefore, we conclude that intubations in medical wards are done by less experienced doctors with lack of facilities and has high incidence of adverse