Jenna Potter, DNP
Nurse Practitioner
University of Minnesota, United States
Disclosure information not submitted.
Anna Benson, PharmD
Pharmacist
University of Minnesota, United States
Disclosure information not submitted.
Jared Larson, PharmD
Pharmacist
University of Minnesota, United States
Disclosure information not submitted.
Katie Pendleton, MD
Assistant Professor of Medicine
University of Minnesota, United States
Disclosure information not submitted.
Title: Pre-Intubation Huddle to Reduce Peri-Intubation Adverse Events in the Critically Ill
Introduction: Emergency intubation in critically ill patients is often associated with adverse events including hypoxia, hemodynamic instability, and cardiac arrest which may occur in up to 45% of patients1. We hypothesized that poor planning and failure to identify at-risk patients increases the risk of adverse events. Therefore, we embarked upon a quality improvement project to reduce peri-intubation adverse events.
Methods: Pre-intervention data was collected consisting of patient vital signs pre- and post-intubation as well as medications used for induction and vasopressors required. A pre- and post-intubation team huddle, with representatives from the anesthesia airway team and the ICU team caring for the patient, was instituted to improve communication and identification of high risk patients. The huddle included a checklist to prompt discussion of the patient’s current respiratory status, hemodynamic concerns, vasopressors to be prepared, planned induction medications, and verification of all necessary equipment and personnel. A member of the research team met with both the anesthesia and ICU teams pre-intervention to explain the purpose of the huddle. Data collection was resumed post-intervention to assess outcomes.
Results: Baseline data from 20 critically ill patients requiring emergent airway management in the ICU were included. One of three adverse events including hypoxia defined by SpO2< 80%, hemodynamic instability defined by SBP< 70, and cardiac arrest occurred in 55% of pre-intervention patients with 10% of patients having a cardiac arrest. Preliminary data post-intervention of 16 patients revealed 87% participation in the pre-intubation huddle. Major adverse events decreased to 25% and no patient suffered a cardiac arrest. Post-intervention data collection is ongoing.
Conclusions: Institution of a pre-intubation team huddle at our institution resulted in a significant reduction in major peri-intubation adverse events. We hypothesize this reduction in adverse events is due to improved communication between team members, improved identification of high risk patients, and better preparation for this high risk procedure.
1. Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021;325(12):1164–1172.