Etomidate and Airway Management Practices

• Background Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices.• Objectives To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists.• Methods A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices.• Results A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years’ experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did.• Conclusions Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.

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Current Practice in Airway Management: A Descriptive Evaluation

American Journal of Critical Care ◽

10.4037/ajcc2009803 ◽

2010 ◽

Vol 19 (2) ◽

pp. 168-173 ◽

Cited By ~ 5

Author(s):

Rebecca Kjonegaard ◽

Willa Fields ◽

Major L. King

Keyword(s):

Mechanical Ventilation ◽

Airway Management ◽

Registered Nurses ◽

Management Practices ◽

Current Practice ◽

Ventilator Associated Pneumonia ◽

Convenience Sample ◽

Evidence Based Practices ◽

Respiratory Therapists ◽

Care Workers

Background Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. Objectives To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. Methods A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Results Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients’ teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Conclusion Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

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Airway Management Issues in the Intensive Care Unit: Revisiting Old Paradigms and Broadening Our Horizons

The Heart Surgery Forum ◽

10.1532/hsf98.20101019 ◽

2011 ◽

Vol 14 (2) ◽

pp. 99 ◽

Cited By ~ 1

Author(s):

Jeffrey P. Keck ◽

Thomas C. Mort

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Airway Management ◽

Management Practices ◽

Improve Patient Safety ◽

Management Skills ◽

First Responder ◽

Skill Sets ◽

Improve Patient ◽

Management Issues

Airway management in the intensive care setting provides unique challenges that can be quite daunting, even for the most experienced practitioner. Airways are usually intubated for long periods, multiple comorbidities often interfere with "routine" airway management practices, and patients are often physiologically disadvantaged or hemodynamically unstable. Strapped with this calamity, the first responder to a patient with an acutely compromised airway is often someone less experienced with global airway management skills. As anesthesiologists, we are very familiar with the skill sets necessary to handle these predicaments, and as intensivists, we have the fortunate opportunity to share that wealth of information and experience. Airway care in the intensive care unit is a continuumfrom elective or emergent intubation, to airway preservation and hygiene, to elective or unintentional extubation. Thus, familiarization with the basics of airway management in routine and "first responder" settings should bolster confidence and greatly improve patient safety and outcomes.

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