• Manuel Taboada, Raúl Rey, Susana Martínez, Rosa Soto-Jove, Paula Mirón, Salome Selas, María Eiras, Adrian Martínez, María Rial, Agustin Cariñena, Irene Rodríguez, Sonia Veiras, Julián Álvarez, Aurora Baluja, and Peter G Atanassoff.
• From the Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain (MT, RR, SM, RS-J, PM, SS, ME, AM, MR, AC, IR, SV, JA, AB) and The Department of Anesthesiology, University of Basel, Basel, Switzerland (PGA).
• Eur J Anaesthesiol. 2020 Jan 1; 37 (1): 25-30.

BackgroundAfter cardiac surgery, a patient's trachea is usually extubated; however, 2 to 13% of cardiac surgery patients require reintubation in the ICU.ObjectiveThe objective of this study was to compare the initial intubation in the cardiac operating room with reintubation (if required) in the ICU following cardiac surgery.DesignA prospective, observational study.SettingDepartment of Anesthesiology and Intensive Care Medicine, Clinical Hospital of Santiago, Spain.PatientsWith approval of the local ethics committee, over a 44-month period, we prospectively enrolled all cardiac surgical patients who were intubated in the operating room using direct laryngoscopy, and who required reintubation later in the ICU.Main Outcome MeasuresThe primary endpoint was to compare first-time success rates for intubation in the operating room and ICU. Secondary endpoints were to compare the technical difficulties of intubation (modified Cormack-Lehane glottic view, operator-reported difficulty of intubation, need for support devices for direct laryngoscopy) and the incidence of complications.ResultsA total of 122 cardiac surgical patients required reintubation in the ICU. Reintubation was associated with a lower first-time success rate than in the operating room (88.5 vs. 97.6%, P = 0.0048). Reintubation in the ICU was associated with a higher incidence of Cormack-Lehane grades IIb, III or IV views (34.5 vs. 10.7%, P < 0.0001), a higher incidence of moderate or difficult intubation (17.2 vs. 6.5%, P = 0.0001) and a greater need for additional support during direct laryngoscopy (20.5 vs. 10.7%, P = 0.005). Complications were more common during reintubations in the ICU (39.3 vs. 5.7%, P < 0.0001).ConclusionCompared with intubations in the operating room, reintubation of cardiac surgical patients in the ICU was associated with more technical difficulties and a higher incidence of complications.Clinical Trial NumberEthics committee of Galicia number 2015-012.

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