Implementing an Intubation Guideline in the Intensive Care Unit

Background: Intubation, even when done properly, can have negative consequences. Roughly 6% of patients intubated in the emergency department acquire hypoxia as a result intubation, or while intubated (Brown, 2021). "Endotracheal intubation in the intensive care unit (ICU) carries with it a higher morbidity and mortality, likely due to many factors, including a lack of physiologic reserve. For example, the incidence of a difficult airway in the ICU may be as high as 23%. Moreover, the use of a systematic approach to, or protocol for, endotracheal intubation may reduce intubation complications" (Jaber et al. 2010). Hypoxemia and cardiovascular collapse represent the initial and most serious life-threatening complications associated with difficult airway access in the critically ill (Jaber et al. 2006). Proper planning and preparation can prevent many adverse events for patients and practitioners. Having an intubation guideline in the ICU has proven to reduce complications from intubation. Methods: A quality improvement project to reduce the complications due to failed intubation in the ICU. Prior to the intervention, health care providers were assessed regarding their knowledge of current intubation guidelines and evidence-based practice. A new intubation guideline with a provision for the management of a difficult airway was implemented in the intensive care unit. In conjunction, an education module was provided for instruction on new guideline and management of difficult airways. A post-implementation survey of healthcare providers was given to assess knowledge retention after education and implementation. Results: Post-implementation, the survey found 90 percent (n=9) reported of clinicians felt comfortable and 10 percent (n=1) reporting somewhat comfortable with intubation in the ICU. The participants reported that 90 percent (n=9) reported feeling more comfortable and 10 percent (n=1) reporting neither more or less comfortable when managing difficult airways. All of respondents (n=10) stated satisfaction with the new guideline, believed it to be a good resource for ICU, and would utilize it in future practice. No failed intubations were reported during the implementation period using the new guideline. Conclusion: Having an intubation guideline in the ICU has proven to reduce complications from intubation. Clinicians at this project site agree that the new intubation guideline is a useful resource for airway management and will utilize when performing endotracheal intubation and managing difficult airways.