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Data Tables

Pulmonary Disorders I

Grace E. Benanti ~2 min read Module 18 of 20

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Pulmonary Disorders I

II.INTUBATION

A.Endotracheal Intubation

Provides access for suctioning of tracheobronchial secretions, maintains a patent airway, and allows

administration of medications

2Indications include airway protection, facilitation of ventilation and oxygenation, assurance of airway

patency, and induction of anesthesia for surgery.

Orotracheal intubation is preferred for elective and emergency cases.

Nasotracheal intubation is beneficial for patients undergoing maxillofacial surgery or dental procedures

and for patients with limited mouth opening. This route may be associated with increased risk of bleeding

and sinusitis. As a result, it should be avoided in patients with severe nasal or midface trauma.

Complications include insertion trauma, gastric aspiration, hypoxemia, laryngospasm, esophageal

intubation, right main bronchus intubation, cardiac arrhythmias, and hemodynamic impairment.

B.Rapid Sequence Intubation (RSI)

Rapid and sequential administration of a rapid-acting induction agent and a NMBA to facilitate intubation

and decrease the risk of aspiration

2Series of seven distinct steps: preparation, preoxygenation, pretreatment or more contemporarily

preintubation optimization, induction either prior or with paralysis, protection and positioning, placement

of the tube in the trachea, and management after intubation

C.Clinical Practice Guideline on Rapid Sequence Intubation

These recently published guidelines were developed to provide evidence-based recommendations on

pharmacologic and nonpharmacologic topics related to RSI (Critical Care Medicine 2023;51:1411-30).

2Overall, 10 clinically relevant guideline statements involving specific aspects of RSI were finalized;

however, a summary of medication-related aspects of RSI are summarized below (Table 6).

Table 6. Clinical Practice Guideline Rapid Sequence Intubation Medication-Related Recommendations

RSI Step

Summary

GRADE Recommendation

Pretreatment

Not reported

Induction

Suggest sedative-hypnotic induction agent when neuro-

muscular blocking agent will be used

Best practice statement

(level of evidence not graded)

No difference suggested between etomidate and other

induction agents regarding outcomes (survival, hypoten-

sion risk, or need for vasoactive support)

Conditional

(moderate level of evidence)

Suggest against the use of corticosteroids following

etomidate administration

Conditional

(low level of evidence)

Paralysis

Recommend administering neuromuscular blocking

agent following induction

Strong

(low level of evidence)

Suggest administering either rocuronium or succinylcho-

line (if no contraindications)

Conditional

(low level of evidence)

RSI = rapid sequence intubation.

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