Background
Endotracheal intubation is a common intervention in Intensive Care Unit (ICU) associated with a high incidence of difficult intubation and complications. We hipothesized that reintubations in ICU would be associated with more technical difficulty and complications compared with first intubation.

Methods 
We prospectively evaluated during 34 months all patients that were intubated using a direct laryngoscopy and posteriorly reintubated in the ICU. The purpose of this study was to compare first time success rate, technical difficulty of intubation (number of attempts, need for adjunts to direct laryngoscopy, glottic visualization using the modified Cormack-Lehane grade),  and the incidence of complications during intubation (Hypotension, Hypoxia, esophageal intubation)

Results and discussion
A total of 340 patients were intubated in ICU, of which 48 (14%) were reintubated posteriorly. The glottic visualization, number of intubation attempts, the need for adjuncts to direct laryngoscopy and complications during intubation are present in table 1. No difference in the number of attempts of intubation were observed between the first intubation and the reintubation. Reintubation was associated with worse glottic visualization, with more use of gum-elastic bougie, and more complications compared with first intubation. Elmer et al. (1) in a similar study observed no differences in glottic visualization, intubation attempts or the use of the gum-elastic bougie. Only complications were more common during reintubation compared to first intubation in their study.

Conclusions
Compared with first intubation in ICU, reintubation using a direct lalyngoscopy was associated with worse glottic views, an increase of the technical difficulty of intubation and the incidence of complications. Further studies are required to confirm these findings

References
(1) Elmer et al. Reintubation in critically ill patients: procedural complications and implications for care. Critical Care 2015; 19.112-18.

09 / Have reintubation in Intensive Care Unit more technical difficulty and complications in comparison with first intubation? A prospective, observational study