Intubation performed in the Emergency department is associated with increased pulmonary complications

Samer Ibrahim DO; Krishna Akella DO; Chendrasekhar Akella

Volume : VIII, Issue : V, May - 2019

Intubation performed in the Emergency department is associated with increased pulmonary complications

Samer Ibrahim Do, Krishna Akella Do, Chendrasekhar Akella

Abstract :

Ventilator Associated Pneumonia (VAP) is among the most common hospital acquired infections. Trauma patients are known to have a unique predisposition to the development of pneumonia. At our urban level 1 trauma center, we noticed variability in the incidence of aspiration and pneumonia among intubated patients with similar levels of injury severity. In an attempt to discern why, we hypothesized that location of intubation was a risk factor for development of in–hospital complications.

We performed a retrospective cohort study over a 6 month period using adult patients admitted to our trauma service. Intubations performed were reported from four different locations: Emergency Department (ED), operating room (OR), intensive care unit (ICU) and the surgical floor. Data obtained included location of intubation, age, Acute Injury Score (AIS), days on a ventilator, incidence of pulmonary infection, incidence of aspiration, intubation difficulty, ICU length of stay (ICU–LOS), hospital length of stay (HLOS), and survival. One way analysis of variance (ANOVA) was then performed.

Our study included 96 enrolled patients consisting of 13 women and 83 men with a mean age of 49.5. Patients intubated in the ED, in comparison to patients intubated on the surgical floor, ICU or OR, were noted to have a statically significant increase in ventilator days (10.9 days), ICU length of stay (12.1 days), HLOS (18.8 days). Additionally, incidence of pulmonary infection (63.9%) and incidence of aspiration (37.7%) were noted to be increased with no statistically significant change in survival.

In conclusion, trauma patients requiring emergent intubation in the ED are uniquely predisposed towards development of pneumonia and in–hospital morbidity. These patients should be aggressively managed with strategies aimed at VAP prevention.