Making endotracheal intubation safe in intensive care units: Impact of a bundle on the complications related to endotracheal intubation: A quasi-experimental before-after study

• Published in: Indian Journal of Anaesthesia
• Main Authors: Payal Jain, Sagar Shanmukhappa Maddani, Sunil Ravindranath, Souvik Chaudhuri, Shwethapriya Rao, H C Deepa, Vishwas Parampalli
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2025-10-01
• Subjects: airway evaluation; airway management; endotracheal intubation; haemodynamic instability; intensive care unit; intubation bundle; intubation complications; macocha score
• Online Access: https://journals.lww.com/10.4103/ija.ija_106_25
• ISSN: 0019-5049; 0976-2817

Background and Aims: Endotracheal intubation (ETI) in the intensive care unit (ICU) carries significant risks. Peri-intubation care bundles have been shown to reduce severe complications associated with ETI, but they are not routinely implemented due to equipment, drug shortages, and changes in local policies. Therefore, we developed an intubation bundle and assessed its impact on complications. Methods: This study was carried out over 18 months with adult patients requiring ETI in the ICU. The intubation practices and complication rates were evaluated during the pre-implementation phase (Phase I). The ETI bundle was developed based on an analysis of these complications and existing guidelines, and the ICU team was trained on its application. Afterwards, complications during ETI were documented in the post-implementation phase to evaluate the impact of the intubation bundle (Phase II). P values < 0.05 were considered statistically significant. Results: The number of patients with major complications decreased significantly after the introduction of the bundle (45% vs 29%, P < 0.001). Critical haemodynamic instability (HI) was the primary complication, and the use of a bundle was associated with a significant reduction (39% vs 19%, P < 0.001). Additionally, by implementing the bundle led to significant improvements in intubation practices, such as airway assessment by the MACOCHA score, optimisation of patient positioning, and the presence of two intubators. Conclusion: Our study demonstrates that implementing an intubation bundle in ICU settings makes ETI practices safer by decreasing the incidence of life-threatening complications.