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LETTERS TO THE EDITOR

The Implications of Different Failed Endotracheal Intubation Rates

Anesthetic Department, Western Infirmary, Glasgow, Scotland

To the Editor:

Heidegger et al. (1) compared their failed endotracheal intubation rate with that of Rose and Cohen (2). They state that, among other factors, the failed intubation rate depends on the study population. Other factors include the definitions used and departmental practice. Rose and Cohen’s failure rate of 0.3% refers only to the first technique attempted (2). Tracheal intubation was achieved with an alternative technique under the same general anesthetic in 31% of their "failed intubation" patients. Immediate awake intubation was successful in 33%. Thus, the true failure rate is about 0.1%. Rose and Cohen state that the failure rate of the first technique "may reflect a preference to discontinue attempts early and to proceed to alternative management prior to significant airway trauma." More frequent failure rates may be a consequence of practice designed to minimize airway trauma and indicate a high standard of care.

The failed intubation rate achieved by Heidegger et al. (1) is low. However, a few more details would increase the value of their report. The vocal cords could not be seen in 1016 patients, and 172 of these patients underwent secondary fiberoptic intubation. The authors gave detailed accounts of nine patients. Were the remaining 835 patients intubated within two attempts with the Macintosh laryngoscope? How many attempts were made, and what was their duration (median and range for both) in these 835 patients and in the 172 who had secondary fiberoptic intubation?

We wish to prevent hypoxic or soft tissue damage in difficult intubation patients. Good outcome is more important than the failed intubation rate.

References

1. Heidegger T, Gerig HJ, Ulrich B, Kreienbühl G. Validation of a simple algorithm for tracheal intubation: Daily practice is the key to success in emergencies—an analysis of 13,248 intubations. Anesth Analg 2001; 92: 517–22.[Abstract/Free Full Text]
2. Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41: 372–83.[Web of Science][Medline]

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