Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation
Open accessAbstract
Study objective Desaturation during intubation has been associated with serious complications, including dysrhythmias, hemodynamic decompensation, hypoxic brain injury, and cardiac arrest. We seek to determine the incidence and duration of oxygen desaturation during emergency department (ED) rapid sequence intubation. Methods This study included adult rapid sequence intubation cases conducted between September 2011 and July 2012 in an urban, academic, Level I trauma center ED. We obtained continuous vital signs with BedMasterEX data acquisition software. Start and completion times of rapid sequence intubation originated from nursing records. We defined oxygen desaturation as (1) cases exhibiting SpO2 reduction to less than 90% if the starting SpO2 was greater than or equal to 90%, or (2) a further reduction in SpO2 in cases in which starting SpO2 was less than 90%. We used multivariable logistic regression to predict oxygen desaturation during rapid sequence intubation. Results During the study period, there were 265 rapid sequence intubation cases. The study excluded 99 cases for failure of electronic data acquisition, inadequate documentation, or poor SpO2 waveform during rapid sequence intubation, and excluded cases managed by anesthesia providers, leaving 166 patients in the analysis. After preoxygenation, starting SpO2 was greater than 93% in 124 of 166 cases (75%) and SpO2 was less than 93% in the remaining 46 cases. Oxygen desaturation occurred in 59 patients (35.5%). The median duration of desaturation was 80 seconds (interquartile range 40, 155). Multivariable analysis demonstrated that oxygen desaturation was associated with preintubation SpO2 less than 93% (odds ratio [OR] 5.1; 95% confidence interval (CI) 2.3 to 11.0), multiple intubation attempts (>1 attempt) (OR 3.4; 95% CI 1.4 to 6.1), and rapid sequence intubation duration greater than 3 minutes (OR 2.7; 95% CI 1.2 to 6.1). Conclusion In this series, 1 in 3 patients undergoing ED rapid sequence intubation experienced oxygen desaturation for a median duration of 80 seconds. Preintubation saturation less than 93%, multiple intubation attempts, and prolonged intubation time are independently associated with oxygen desaturation. Clinicians should use strategies to prevent oxygen desaturation during ED rapid sequence intubation.
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The incidence of peri-intubation desaturation, hypocapnea, and hypotension in emergency intubations is relatively high.
“Given the relatively high incidence of peri-intubation desaturation, hypocapnea, and hypotension in emergency intubations”
From Airway Management in Trauma (2018) · cites this paper as [24]
The Main Results report oxygen desaturation in 59 of 166 emergency department rapid sequence intubations (35.5%). The paper does not report incidence rates for peri-intubation hypocapnea or hypotension; its discussion of hemodynamic instability does not establish their incidence. (LLM, conf=0.90)
Experimental — accuracy not yet measuredHypoxemia during emergency department RSI is common, occurring in more than one-third of cases.
“Hypoxemia during emergency department (ED) RSI is common, occurring in more than one-third of cases.24”
From Airway Management in Trauma (2018) · cites this paper as [24]
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Research works printed but not linked: 27
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Bodily, J. B., Webb, H. R., Weiss, S. J., & Braude, D. A.
- Affiliations
- University of New Mexico Health Sciences Center (US)
- Corresponding author
- Braude, Darren A.
- ORCID
- Braude, Darren A.
- Venue
- Annals of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 67
- Issue
- 3
- Pages
- 389-395
- ISSN
- 0196-0644 (ISSN-L)
- OpenAlex
- W1578489208
- Cited by
- 83
- References
- 0
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 1 · 2023: 11 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 6 · 2018: 9 · 2017: 9 · 2016: 8
- FWCI
- 11.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Keywords
- oxygen desaturation, rapid sequence intubation, emergency department intubation, preoxygenation, intubation complications, intubation attempts, intubation time, hypoxemia, trauma patients, cardiac arrest, hypoxic brain injury, cardiac arrhythmias, hemodynamic decompensation
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Hypoxia, Cross-Sectional Studies, Emergency Service, Hospital, Female, Hospitals, Urban, Humans, Intubation, Intratracheal, Laryngoscopy, Male, Middle Aged, Oximetry, Oxygen, Time Factors, Incidence, Vital Signs
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