EMERGENCY INTUBATION GUIDELINE

This guideline was produced in response to the findings of the N-TEAM study in 2022. 

This looked at emergency airway management outside theatres across the KSS deanery and found a high rate (50%) of associated complications. These included desaturation to < 80% in 13% and hypotension (systolic blood pressure < 80 mmHg) in 25% of cases. At Worthing Hospital in particular, we noted that propofol was usually the induction agent of choice, despite its association with worsening haemodynamic instability in critically ill patients.

The new intubation guideline is available on posters around the anaesthetic and ICU department. Laminated copies are available for quick reference on the anaesthetic machine in A&E resus, in the airway grab bags and on the difficult airway trolley on ICU. An intubation checklist (approved by FICM / RCoA / DAS) is on the reverse side of this.

Recommendations from the new guideline:

• Minimising use of propofol as an induction agent for intubation due to hypotension. 

• Intubating teams may feel particular drugs are indicated for the particular patient, but we'd recommend fentanyl/ketamine/rocuronium as a good first line choice.

• Videolaryngoscopy as first line for all intubations outside theatres.

• Where possible, at least 2 airway trained doctors present at intubations.

• Emphasis on resuscitation before intubation with fluid / blood / vasopressors and use of an arterial line (if time permits) for haemodynamic monitoring.