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Vol. 48. Issue 1.
Pages 14-22 (January 2024)
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Visits
1983
Vol. 48. Issue 1.
Pages 14-22 (January 2024)
Original article
Improvement in intubation success during COVID-19 pandemic with a simple and low-cost intervention: A quasi-experimental study
Mejoría del éxito en la intubación durante la pandemia covid-19 con una intervención simple y de bajo costo: estudio cuasi-experimental
Visits
1983
Guillermo Jesús Mauroa,
Corresponding author
guillejmauro@hotmail.com

Corresponding author.
, Gustavo Armandob, Lorena Natalia Cabillóna, Santiago Tomás Beniteza, Sabrina Mogliania, Amanda Roldana, Marisol Vilcaa, Ricardo Rolliea, Gustavo Martinsa
a Servicio de Emergencias, Hospital Interzonal de Agudos San Martín de La Plata, La Plata, Argentina
b Instituto Nacional de Enfermedades Respiratorias "Dr. Emilio Coni", Argentina
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Figures (2)
Tables (4)
Table 1. Characteristics of patients undergoing tracheal intubation during two stages.
Table 2. Characteristics of the intubation procedure.
Table 3. Multivariate logistic regression model.
Table 4. Intubation complications among two instances.
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Additional material (1)
Abstract
Objectives

primary objective: to improve the FPS rates after an educational intervention. Secondary objective: to describe variables related to FPS in an ED and determine which ones were related to the highest number of attempts.

Design

it was a prospective quasi-experimental study.

Setting

done in an ED in a public Hospital in Argentina.

Patients

there were patients of all ages with intubation in ED.

Interventions

in the middle of the study, an educational intervention was done to improve FPS. Cognitive aids and pre- intubation Checklists were implemented.

Main variables of interest

the operator experience, the number of intubation attempts, intubation judgment, predictors of a difficult airway, Cormack score, assist devices, complications, blood pressure, heart rate, and pulse oximetry before and after intubation All the intubations were done by direct laryngoscopy (DL).

Results

data from 266 patients were included of which 123 belonged to the basal period and 143 belonged to the post-intervention period. FPS percentage of the pre-intervention group was 69.9% (IC95%: 60.89–77.68) whereas the post-intervention group was 85.3% (IC95%: 78.20–90.48). The difference between these groups was statistically significant (p=0.002). Factors related to the highest number of attempts were low operator experience, Cormack-Lehane 3 score and no training.

Conclusions

a low-cost and simple educational intervention in airway management was significantly associated with improvement in FPS, reaching the same rate of FPS than in high income countries.

Keywords:
Endotracheal intubation
Advanced airway
Emergency department
Team work
Airway education
Resumen
Objetivos

objetivo principal: mejorar la tasa de éxito de intubación luego de una intervención educativa. Objetivo secundario: describir las variables asociadas con el éxito en el primer intento (EPI) y determinar cuáles se relacionaron con mayor número de intentos.

Diseño

estudio prospectivo cuasi-experimental. Ámbito: realizado en un SE de un Hospital público de Argentina.

Pacientes

se incluyeron todos aquellos pacientes intubados en el SE en el período de estudio.

Intervención

en la mitad del estudio, se realizó una intervención educativa, se implementaron ayudas cognitivas y listas de verificación preintubación. Todas las intubaciones se realizaron por laringoscopia directa.

Variables de interés principales

experiencia del operador, número de intentos de intubación, criterios de intubación, predictores de vía aérea difícil, grado de Cormack, dispositivos facilitadores utilizados, complicaciones y los signos vitales antes y después de la intubación.

Resultados

se incluyeron datos de 266 pacientes de los cuales 123 pertenecían al período basal y 143al período postintervención. El porcentaje de éxito del grupo preintervención fue del 69,9% (IC95%: 60,89-77,68) mientras que el grupo postintervención fue del 85,3% (IC95%: 78,20-90,48). La diferencia entre estos grupos fue estadísticamente significativa (p=0,002). Los factores relacionados con el mayor número de intentos fueron la baja experiencia del operador, el grado de Cormack-Lehane 3 y la falta de capacitación.

Conclusiones

una intervención educativa simple y de bajo costo en el manejo de la vía aérea se asoció significativamente con la mejora en el éxito del primer intento de intubación, alcanzando los porcentajes de los países de altos ingresos.

Palabras clave:
Intubación endotraqueal
Vía aérea avanzada
Departamento de emergencia
Trabajo en equipo
Educación en vía aérea

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