Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications

Critical Care Medicine, 05/30/2012

The use of neuromuscular blocking agents, when used by intensivists with a high level of training and experience, is associated with a decrease in procedure–related complications.

Methods

  • Five hundred sixty–six patients undergoing emergent intubations in two tertiary care centers, Massachusetts General Hospital, Boston, MA, and the University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA, were enrolled in a prospective, observational study.
  • The 112 patients intubated during cardiopulmonary resuscitation were excluded, leaving 454 patients for analysis.
  • All intubations were supervised by attendings trained in Critical Care Medicine.
  • The authors measured intubating conditions, oxygen saturation during and 5 mins following intubation.
  • They assessed the prevalence of procedure–related complications defined as esophageal intubation, traumatic intubation, aspiration, dental injury, and endobronchial intubation.

Results

  • The use of neuromuscular blocking agents was associated with a lower prevalence of hypoxemia (10.1% vs. 17.4%, p = .022) and a lower prevalence of procedure–related complications (3.1% vs. 8.3%, p = .012).
  • This association persisted in a multivariate analysis, which controlled for airway grade, sedation, and institution.
  • Use of neuromuscular blocking agents was associated with significantly improved intubating conditions (laryngeal view, p = .014; number of intubation attempts, p = .049).
  • After controlling for the number of intubation attempts and laryngoscopic view, muscle relaxant use is an independent predictor of complications associated with emergency intubation (p = .037), and there is a trend towards improvement of oxygenation (p = .07).

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