Evidence-based Emergency Tracheal Intubation

Millions of critically ill adults undergo tracheal intubation in an emergency department or ICU each year, nearly 40% of whom experience hypoxemia, hypotension, or cardiac arrest during the procedure. Over the last two decades, a series of randomized trials have examined which of the tools, techniques, devices, and drugs used to perform emergency tracheal intubation improve outcomes and which are ineffective or harmful. Results of these trials have demonstrated that preoxygenation with noninvasive ventilation and administration of positive pressure ventilation between induction and laryngoscopy prevent hypoxemia during intubation, video laryngoscopy facilitates successful intubation on the first attempt and may prevent esophageal intubation, use of a stylet is superior to intubation with an endotracheal tube alone and is comparable with use of a bougie, and administration of a fluid bolus before induction does not prevent hypotension. Many additional decisions clinicians face during emergency tracheal intubation are not yet informed by rigorous evidence. Randomized trials must continue to examine systematically each aspect of this common and high-risk procedure to improve patient outcomes and bring forth an era of evidence-based emergency tracheal intubation.

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Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians

Learning Objectives

At the conclusion of this activity, learners should be able to:

  • Describe an evidenced-based approach to emergency tracheal intubation
  • Discriminate between strategies of preoxygenation that reduce the incidence of hypoxemia in the critically ill adult
  • Identify decisions in emergency tracheal intubation where multiple acceptable treatment options exist without clear evidence of superiority
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)™
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation
Publication Date: 
07/01/2025
Credit Expires: 
07/01/2027
Cost:
$25.00
Rating: 
0

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Accreditation Statement

The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Disclosure Declaration

Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

Stephanie C. DeMasi, M.D. (Vanderbilt University Medical Center, Nashville, TN, USA) has received support from the NIH (5T32GM108554 SCD).

Jonathan D. Casey, M.D., M.Sc.D. (Vanderbilt University Medical Center and Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA) has been supported by grants from the NIH/NCATS, the NIH/NHLBI, and the Patient-Centered Outcomes Research Institute. He has received a travel grant from Fisher and Paykel to attend a conference.

Matthew W. Semler, M.D., M.Sc. (Vanderbilt University Medical Center and Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA) has been supported by the NIH/NCATS, the NIH/NHLBI, the Department of Defense, and the Patient-Centered Outcomes Research Institute. He has received compensation from Baxter Healthcare Corporation for delivering a virtual lecture at a conference and from DynaMedex for peer-reviewing evidence-based practice articles. He has received compensation from Baxter Healthcare Corporation for delivering a virtual lecture at a conference and for serving on a medical advisory board.

AJRCCM CME Planners

Edward Schenck, M.D. Associate Editor, AJRCCM

Dr. Schenck reported that he is a consultant for Axle Informatics

Off-Label Usage Disclosure

None

All relevant financial relationships have been reviewed and mitigated.

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Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)™
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation

Price

Cost:
$25.00
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