Article Dans Une Revue Critical Care Medicine Année : 2024

Diabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials

Micah Long
Bryan Krause
  • Fonction : Auteur
John Dollerschell
  • Fonction : Auteur
J. Michael Brewer
  • Fonction : Auteur
John Gaillard
  • Fonction : Auteur
Sheetal Gandotra
  • Fonction : Auteur
Shekhar Ghamande
  • Fonction : Auteur
Kevin Gibbs
  • Fonction : Auteur
Adit Ginde
  • Fonction : Auteur
Christopher Hughes
  • Fonction : Auteur
David Janz
  • Fonction : Auteur
Akram Khan
  • Fonction : Auteur
Andrew Latimer
  • Fonction : Auteur
Steven Mitchell
  • Fonction : Auteur
David B Page
  • Fonction : Auteur
Matthew Semler
  • Fonction : Auteur
Susan Stempek
  • Fonction : Auteur
Stacy Trent
  • Fonction : Auteur
Stephen Halliday
  • Fonction : Auteur

Résumé

Objectives: Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults. Design: A secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG). Setting: Emergency departments (EDs) or ICUs at 11 centers across the United States that enrolled in randomized trials of a pre-intubation checklist, fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie vs. stylet. Patients: Critically ill adults undergoing tracheal intubation with a laryngoscope in an ED or an ICU. Interventions: None. Measurements and Main Results: A total of 2654 patients were included in this analysis, of whom 638 (24.0%) had diabetes mellitus. The mean time from induction of anesthesia to intubation of the trachea was 169 seconds ( sd , 137s). Complications occurred during intubation in 1007 patients (37.9%). Diabetes mellitus was not associated with the time from induction of anesthesia to intubation of the trachea (–4.4 s compared with nondiabetes; 95% CI, –17.2 to 8.3 s; p = 0.50). Use of a video vs. direct laryngoscope did not modify the association between diabetes mellitus and the time from induction to intubation ( p for interaction = 0.064). Diabetes mellitus was not associated with the probability of successful intubation on the first attempt (85.6% vs. 84.3%; p = 0.46) or complications during intubation (39.8% vs. 37.4%; p = 0.52). Conclusions: Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation.

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hal-04876349 , version 1 (10-04-2025)

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Micah Long, Bryan Krause, Audrey de Jong, John Dollerschell, J. Michael Brewer, et al.. Diabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials. Critical Care Medicine, 2024, 53 (1), pp.e65-e73. ⟨10.1097/CCM.0000000000006460⟩. ⟨hal-04876349⟩
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