Observational studyPloS one2026
Adult airway management in ICU and regular floors: A prospective study as part of a healthcare improvement initiative in a tertiary care center.
Observational study in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite recent advancements, airway management outside the operating room (OR) remains a challenging task and is associated with a high rate of complications. The first pass success rate at our institution was low. We developed a standardized multidisciplinary protocol to improve it as part of a healthcare improvement initiative.
methodsFollowing the implementation of the protocol, this prospective observational study was conducted on patients over 18 years old requiring intubation by anesthesia providers on regular floors and in intensive care units. The primary outcome was the first-attempt success rate of endotracheal intubation. Secondary outcomes included total number of attempts, time to successful intubation, equipment and medications used, and occurrence of adverse events such as severe hypotension (systolic blood pressure (SBP) ≤80 mmHg), severe hypoxemia (SpO2 ≤ 85%), and cardiac arrest.
resultsAll 199 patients were successfully intubated, with 184 patients (92.5%) intubated at first attempt. Twenty-four patients had a baseline SBP ≤ 80 mmHg, with 35 additional patients experiencing a drop in blood pressure during intubation. Thirty-eight patients had a baseline SpO2 ≤ 85%, with 11 additional patients experiencing desaturation during intubation. Two patients had cardiac arrest during intubation and were resuscitated. Multivariable logistic regression identified SpO2 ≤ 85% as the only predictor of hypoxemia (OR: 22.85, 95%CI: 9.07-57.55, P < 0.001) and baseline hypotension as the only predictor of hypotension during intubation (OR: 32.43, 95%CI: 7.14-147.33, P < 0.001).
conclusionImplementing a standardized multidisciplinary protocol that includes highly experienced anesthesia providers and the use of muscle relaxants resulted in a very high first-attempt intubation success rate in critically ill patients, with the persistence of a high incidence of adverse events. Our successful approach may inform other policymakers about best practices for safe intubation in high-risk patients, highlighting the need for strategies to mitigate hemodynamic and respiratory complications and encouraging them to implement airway healthcare improvement initiatives in their institutions.
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