Complications of emergency intubation with and without paralysis

Expert and definitive airway management is fundamental to the practice of e mergency medicine. In critically ill patients, rapid sedation and paralysis , also known as rapid-sequence intubation, is used to facilitate endotrache al intubation in order to minimize aspiration, airway trauma, and other com plications of airway management. An alternative method of emergent endotrac heal intubation, intubation minus paralysis, is performed without the use o f neuromuscular blocking agents. The present study compared complications o f these two techniques in the emergency setting. Sixty-seven intubations mi nus paralysis were prospectively compared with 166 rapid sequence intubatio ns, Complications were greater in number and severity in the nonparalyzed g roup and included aspiration (15%), airway trauma (28%), and death (3%). No ne of these difficulties were observed in the rapid sequence group (P < .00 01). These results show that rapid sequence intubation when compared with i ntubation minus paralysis significantly reduces complications of emergency airway management and should be made available to emergency physicians trai ned in its use. Copyright (C) 1999 by W.B. Saunders Company.