A modified Montpellier protocol for intubating intensive care unit patients is associated with an increase in first-pass intubation success and fewer complications


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Abstract

Background:The Montpellier protocol for intubating patients in the intensive care unit (ICU) is associated with a decrease in intubation-related complications. We sought to determine if implementation of a simplified version of the Montpellier protocol that removed selected components and allowed for a variety of pre-oxygenation modalities increased first-pass intubation success and reduced intubation-related complications.Methods:A prospective pre/post-comparison of a modified Montpellier protocol in two medical and one medical/surgical/cardiac ICU within a hospital system. The modified eight-point protocol included: fluid administration, ordering sedation, two intubation trained providers, pre-oxygenation with non-invasive positive pressure ventilation, nasal high flow cannula or non-rebreather mask, rapid sequence intubation, capnography, sedation administration, and vasopressors for shock.Results:Patient characteristics and indications for intubation were similar for the 275 intubations in the control (137) and intervention (138) periods. In the intervention vs. control periods, the modified Montpellier protocol was associated with a significant 16.2% [95% CI: 5.1–30.0%] increase in first-pass intubation success and a 12.6% [95% CI: 1.2–23.6%] reduction in all intubation-related complications.Conclusion:A simplified version of the Montpellier intubation protocol for intubating ICU patients was associated with an improvement in first-pass intubation success rates and a reduction in the rate of intubation-related complications.HighlightsOur modified Montpellier Protocol is readily adapted and easily adhered to in the ICU setting.Our modified Montpellier protocol was associated with a 16.2% [95% CI: 5.1-30.0%] increase in first-pass intubation success.Additionally, it was associated with a 12.6% [95% CI: 1.2-23.6%] reduction in all intubation-related complications.

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