Intubation difficulty in poisoned patients: Association with initial Glasgow Coma Scale score

Objective: To determine whether the initial Glasgow Coma Scale (GCS) score is predictive of intubation difficulty in out-of-hospital airway management of poisoned patients. Methods: A prospective, observational study was performed in a toxicological intensive care unit of a university hospital and in a physician-based out-of-hospital care system. Subjects included consecutive poisoned patients intubated during their airway management by out-of-hospital medical teams before hospitalization. The intubating operator (emergency physician or nurse anesthetist) completed a I-page checklist concerning the clinical parameters and circumstances (nature of sedation and difficulty) of endotracheal intubation upon hospital arrival. Results: Forms were completed for all 394 consecutive out-of-hospital intubations. The patients ranged from 15 to 95 years of age (median age 38 years). Most (96%) of the intubations were via the oral route. Intubation difficulty was related to GCS values. Intubation difficulty was seen more often in patients with 7 less than or equal to GCS less than or equal to 19 (36%) than in patients with GCS <7 (15%) or >9 (10%). Not surprisingly, perceived intubation difficulty was least for those patients undergoing rapid-sequence intubation rather than administration of sedation alone. Conclusion: Maximum difficulty of intubation is encountered in poisoned patients with 7 less than or equal to GCS less than or equal to 9. Intubation of such patients appears to be facilitated by appropriate sedation and/or neuromuscular blockade.