Survey of airway management in intensive care units in the UK

Background

Guidelines for minimum standards of monitoring in the anaesthetic room and operating theatres are now part of standard anaesthetic practice throughout the UK. Manipulation of the airway, including tracheal intubation and percutaneous tracheostomies, is a common undertaking in the intensive care unit (ICU). Critically ill patients can pose specific technical difficulties during tracheal intubation. There is no accepted minimum standard of monitoring for procedures involving manipulation of the airway in UK ICUs. We surveyed monitoring practices used for the confirmation of tracheal tube placement during tracheal intubation and percutaneous tracheostomy.

Methods

Anonymous questionnaires were sent to the clinical directors of randomly selected general adult ICUs across the UK.

Results

One hundred and thirty-six replies were received out of 200 questionnaires sent (response rate 68%). The majority (73%) of tracheal intubations were performed by trainee anaesthetists. Only 14% of the ICUs always used end-tidal carbon dioxide (F_ÉCO₂) monitoring during tracheal intubation. Twenty-five per cent of the ICUs did not have a F_ÉCO₂ monitor. Eighty-nine per cent of the ICUs routinely performed percutaneous tracheostomy. Sixty-seven per cent of the ICUs used fibreoptic bronchoscopy to confirm tracheostomy tube position, 7% used F_ÉCO₂ monitoring alone. Seventeen per cent of the ICUs used both. Nine per cent of ICUs relied on clinical signs alone to confirm tracheostomy tube placement. Nearly one-half of the respondents from ICUs without a F_ÉCO₂ monitor cited lack of resources as one of the reasons for not routinely using this monitoring parameter.

Conclusions

Most tracheal intubations in ICUs are performed by trainee anaesthetists, and percutaneous tracheostomy is a widely accepted practice in the UK. Although 75% of units had a F_ÉCO₂ monitor, only a small proportion of intensivists used it to confirm correct placement of the tracheal tube after intubation and percutaneous tracheostomy.