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Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/527

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Title: Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?
Authors: Ono, Yuko
Kikuchi, Hiroaki
Hashimoto, Katsuhiko
Sasaki, Tetsu
Ishii, Jyunya
Tase, Choichiro
Shinohara, Kazuaki
Affiliation: 救急医療学講座
Source title: Journal of anesthesia
Volume: 29
Issue: 5
Start page: 678
End page: 685
Issue Date: Oct-2015
Abstract: PURPOSE: Airway management in severe bronchial asthma exacerbation (BAE) carries very high risk and should be performed by experienced providers. However, no objective data are available on the association between the laryngoscopist's specialty and endotracheal intubation (ETI)-related adverse events in patients with severe bronchial asthma. In this paper, we compare emergency ETI-related adverse events in patients with severe BAE between anesthesiologists and other specialists. METHODS: This historical cohort study was conducted at a Japanese teaching hospital. We analyzed all BAE patients who underwent ETI in our emergency department from January 2002 to January 2014. Primary exposure was the specialty of the first laryngoscopist (anesthesiologist vs. other specialist). The primary outcome measure was the occurrence of an ETI-related adverse event, including severe bronchospasm after laryngoscopy, hypoxemia, regurgitation, unrecognized esophageal intubation, and ventricular tachycardia. RESULTS: Of 39 patients, 21 (53.8 %) were intubated by an anesthesiologist and 18 (46.2 %) by other specialists. Crude analysis revealed that ETI performed by an anesthesiologist was significantly associated with attenuated risk of ETI-related adverse events [odds ratio (OR) 0.090, 95 % confidence interval (CI) 0.020-0.41, p = 0.001]. The benefit of attenuated risk remained significant after adjusting for potential confounders, including Glasgow Coma Score, age, and use of a neuromuscular blocking agent (OR 0.058, 95 % CI 0.010-0.35, p = 0.0020). CONCLUSIONS: Anesthesiologist as first exposure was independently associated with attenuated risk of ETI-related adverse events in patients with severe BAE. The skill and knowledge of anesthesiologists should be applied to high-risk airway management whenever possible.
Publisher: Springer
language: eng
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/527
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/527/1/JAnesth_29_p678.pdf
ISSN: 0913-8668
DOI: 10.1007/s00540-015-2003-2
PubMed ID: 25801541
Other version: http://dx.doi.org/10.1007/s00540-015-2003-2
Rights: © Japanese Society of Anesthesiologists 2015. The final publication is available at link.springer.com.
Appears in Collections:a10 学術雑誌論文等 = Journal Article

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