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Scope of Application
This guideline is intended for physicians working in emergency departments (EDs).
Inclusion Criteria
This guideline is intended for adult patients aged 18 years and older presenting to the ED who require endotracheal intubation.
Exclusion Criteria
This guideline is not intended for pediatric patients or patients undergoing emergent fiberoptic intubation.
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.
For adult patients presenting to the ED requiring endotracheal intubation, are there periprocedural interventions that can reduce the incidence of periintubation hypoxemia?
None specified.
When feasible, optimize preoxygenation using noninvasive ventilation (NIV)* over conventional oxygen therapy (COT) for patients being intubated in the ED.
When NIV is not feasible, consider using high-flow nasal cannula (HFNC) for preoxygenation of hypoxemic patients being intubated in the ED.
Consider video laryngoscopy (VL) when available for patients being intubated in the ED.
Consider using apneic oxygenation (AO) for patients being intubated in the ED. (Consensus)
*Relative contraindications to the use of NIV include patients with increased aspiration risk due to symptoms such as vomiting or decrease level of consciousness and noncompliance due to increased agitation.
None specified.
When feasible, optimize preoxygenation using noninvasive ventilation (NIV)* over conventional oxygen therapy (COT) for patients being intubated in the ED.
When NIV is not feasible, consider using high-flow nasal cannula (HFNC) for preoxygenation of hypoxemic patients being intubated in the ED.
Consider video laryngoscopy (VL) when available for patients being intubated in the ED.
Consider using apneic oxygenation (AO) for patients being intubated in the ED. (Consensus)
*Relative contraindications to the use of NIV include patients with increased aspiration risk due to symptoms such as vomiting or decrease level of consciousness and noncompliance due to increased agitation.
For adult patients presenting to the ED requiring endotracheal intubation, are there periprocedural interventions that can reduce the incidence of peri-intubation hypotension?
None specified.
Use etomidate or ketamine as an induction agent to reduce the risk of peri-intubation hypotension in patients requiring endotracheal intubation in the ED.
Avoid the use of fentanyl, midazolam, or propofol as an induction or coinduction agent in patients requiring endotracheal intubation in the ED who are at increased risk for postintubation hypotension.
None specified.
Use etomidate or ketamine as an induction agent to reduce the risk of peri-intubation hypotension in patients requiring endotracheal intubation in the ED.
Avoid the use of fentanyl, midazolam, or propofol as an induction or coinduction agent in patients requiring endotracheal intubation in the ED who are at increased risk for postintubation hypotension.
