Experts' guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF) : In collaboration with the pediatric Association of French-speaking Anaesthetists and Intensivists (ADARPEF), French-speaking Group of Intensive Care and Paediatric emergencies (GFRUP) and Intensive Care physiotherapy society (SKR)

Hervé Quintard, Erwan l'Her, Julien Pottecher, Frédéric Adnet, Jean-Michel Constantin, Audrey De Jong, Pierre Diemunsch, Rose Fesseau, Anne Freynet, Christophe Girault, Christophe Guitton, Yann Hamonic, Eric Maury, Armand Mekontso-Dessap, Fabrice Michel, Paul Nolent, Sébastien Perbet, Gwenael Prat, Antoine Roquilly, Karim Tazarourte, Nicolas Terzi, Arnaud W Thille, Mikael Alves, Etienne Gayat, Laurence Donetti, Hervé Quintard, Erwan l'Her, Julien Pottecher, Frédéric Adnet, Jean-Michel Constantin, Audrey De Jong, Pierre Diemunsch, Rose Fesseau, Anne Freynet, Christophe Girault, Christophe Guitton, Yann Hamonic, Eric Maury, Armand Mekontso-Dessap, Fabrice Michel, Paul Nolent, Sébastien Perbet, Gwenael Prat, Antoine Roquilly, Karim Tazarourte, Nicolas Terzi, Arnaud W Thille, Mikael Alves, Etienne Gayat, Laurence Donetti

Abstract

Background: Intubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20-50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure.

Results and conclusion: In constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithms.

Figures

Fig. 1
Fig. 1
Algorithm for intubation
Fig. 2
Fig. 2
Algorithm for extubation

References

    1. Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36(2):248–255. doi: 10.1007/s00134-009-1717-8.
    1. De Jong A, Molinari N, Terzi N, Mongardon N, Arnal J-M, Guitton C, et al. Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187(8):832–839. doi: 10.1164/rccm.201210-1851OC.
    1. Le Tacon S, Wolter P, Rusterholtz T, Harlay M, Gayol S, Sauder P, et al. Complications of difficult tracheal intubations in a critical care unit. Ann Fr Anesth Rèanim. 2000;19(10):719–724. doi: 10.1016/S0750-7658(00)00316-6.
    1. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–270. doi: 10.1097/ALN.0b013e31827773b2.
    1. Jaber S, Chanques G, Matecki S, Ramonatxo M, Vergne C, Souche B, et al. Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med. 2003;29(1):69–74. doi: 10.1007/s00134-002-1563-4.
    1. Wang J, Ma Y, Fang Q. Extubation with or without spontaneous breathing trial. Crit Care Nurse. 2013;33(6):50–55. doi: 10.4037/ccn2013580.
    1. Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29(5):1033–1056. doi: 10.1183/09031936.00010206.
    1. Girard TD, Kress JP, Fuchs BD, Thomason JWW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet Lond Engl. 2008;371(9607):126–134. doi: 10.1016/S0140-6736(08)60105-1.
    1. Girard TD, Ely EW. Protocol-driven ventilator weaning: reviewing the evidence. Clin Chest Med. 2008;29(2):241–252. doi: 10.1016/j.ccm.2008.02.004.
    1. Thille AW, Richard J-CM, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187(12):1294–1302. doi: 10.1164/rccm.201208-1523CI.
    1. Girault C, Bubenheim M, Abroug F, Diehl JL, Elatrous S, Beuret P, et al. Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. Am J Respir Crit Care Med. 2011;184(6):672–679. doi: 10.1164/rccm.201101-0035OC.
    1. Thille AW, Boissier F, Ben-Ghezala H, Razazi K, Mekontso-Dessap A, Brun-Buisson C, et al. Easily identified at-risk patients for extubation failure may benefit from noninvasive ventilation: a prospective before-after study. Crit Care Lond Engl. 2016;20(1):48. doi: 10.1186/s13054-016-1228-2.
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926. doi: 10.1136/.
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490.
    1. Quintard H, l’Her E, Pottecher J, Adnet F, Constantin J-M, De Jong A, et al. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med. 2017;36(5):327–341. doi: 10.1016/j.accpm.2017.09.001.
    1. Quintard H, L’Her E, Pottecher J, Adnet F, Constantin J-M, De Jong A, et al. Erratum to Intubation and extubation of the ICU patient [Anaesth. Crit. Care Pain Med. 36 (5) (2017) 327–341] Anaesth Crit Care Pain Med. 2018;37(3):295–296. doi: 10.1016/j.accpm.2018.03.005.

Source: PubMed

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