Nejatian Atosa, Forsberg Ida-Maria, Thorö Ulrika, Sjöblom Albin, Kåhlin Jessica
Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2025 Aug;69(7):e70103. doi: 10.1111/aas.70103.
Endotracheal intubation is a common procedure in the intensive care. However, it is associated with a high incidence of complications, primarily hypotension and hypoxia. Although guidelines advocate the use of checklists for intubation, studies on their effectiveness are limited. The aim was to investigate whether the implementation of a checklist for intubation in an intensive care unit is associated with a reduction in immediate intubation-related complications.
We conducted an observational before and after study, implementing an intubation checklist before the second period. Adult patients intubated between December 2022 and August 2024 at Karolinska University Hospital were included. Data regarding intubations were collected from a quality registry. The primary outcome was a SpO < 90% by pulse oximetry or systolic arterial pressure (SAP) < 90 mmHg within 5 min of intubation. Chi-square or Fisher's exact test was used for the comparison of proportions.
A total of 97 patients were included. There was no significant difference in the primary outcomes of SpO < 90% (30% vs. 21%, p = 0.29) or SAP < 90 mmHg (34% vs. 32%, p = 0.80) before and after checklist implementation. There was no difference in the secondary outcomes of lowest median SpO from intubation until up to 5 min after, surgical airway intervention, cardiovascular collapse, cardiac arrest, oesophageal intubation, severe arrhythmia, or death between the periods. Apnoeic oxygenation, either by standard nasal cannula or high-flow nasal cannula, was used more frequently after checklist implementation (7% vs. 36%, p = 0.005). Preoxygenation with non-invasive ventilation was used in 33% of cases in the standard period compared to 48% in the checklist period (p = 0.19).
In this study on implementing a checklist for intubation of critically ill adults, we could not demonstrate a reduction in immediate intubation-related complications. However, the use of apnoeic oxygenation increased in the checklist period, highlighting the checklist's value as a cognitive aid when preparing for this common yet perilous procedure.
This time interrupted series analysis looked at implementation of a checklist for preparing and planning intubation of ICU patients, where it is recognized that there is risk for respiratory or circulatory adverse events. The findings here from one center showed that implementation of new, detailed checklist-based preparation can affect practice, and that when advanced non-invasive positive pressure ventilatory support is routinely applied, hypoxia can be less frequent then before these were routinely implemented.
Clinicaltrials.gov identifier: (NCT06791317).
气管插管是重症监护中的常见操作。然而，它与高并发症发生率相关，主要是低血压和低氧血症。尽管指南提倡使用插管检查表，但关于其有效性的研究有限。目的是调查在重症监护病房实施插管检查表是否与立即降低插管相关并发症有关。
我们进行了一项前后观察性研究，在第二阶段之前实施插管检查表。纳入2022年12月至2024年8月在卡罗林斯卡大学医院接受插管的成年患者。插管数据从质量登记处收集。主要结局是插管后5分钟内脉搏血氧饱和度（SpO）<90%或收缩动脉压（SAP）<90mmHg。采用卡方检验或Fisher精确检验比较比例。
共纳入97例患者。检查表实施前后，SpO<90%（30%对21%，p=0.29）或SAP<90mmHg（34%对32%，p=0.80）的主要结局无显著差异。两个阶段之间，从插管到插管后5分钟的最低中位SpO、手术气道干预、心血管崩溃、心脏骤停、食管插管、严重心律失常或死亡的次要结局无差异。检查表实施后，标准鼻导管或高流量鼻导管进行的呼吸暂停氧合使用更频繁（7%对36%，p=0.005）。标准阶段33%的病例使用无创通气进行预充氧对比检查表阶段的48%（p=0.19）。
在这项关于为重症成年患者实施插管检查表的研究中，我们未能证明立即降低插管相关并发症。然而，检查表阶段呼吸暂停氧合的使用增加，突出了检查表在准备这一常见但危险操作时作为认知辅助工具的价值。
这项时间序列中断分析研究了ICU患者插管准备和规划检查表的实施情况，其中认识到存在呼吸或循环不良事件的风险。这里来自一个中心的研究结果表明，基于检查表的新的详细准备工作的实施可以影响实践，并且当常规应用先进的无创正压通气支持时，低氧血症可能比这些措施常规实施之前更不频繁。
Clinicaltrials.gov标识符：（NCT06791317）
