Challenge 8

Airway Safety

Airway safety refers to the management and monitoring of the respiratory tract (i.e. mouth, nose, lungs) to ensure air is properly transported to the lungs avoiding any complications that may arise, such as the need for intubation (placing a tube down the trachea) or an unplanned extubation (the tube being dislodged from the trachea before it is ready to be removed).

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Unplanned extubation occurs in over 7% of patients undergoing mechanical ventilation in the Intensive Care Unit and the complications of unplanned extubations result in over $4 billion healthcare costs.1

da Silva, P. S. L., & Fonseca, M. C. M. (2012). Unplanned endotracheal extubations in the intensive care unit: Systematic review, critical appraisal, and evidence-based recommendations. Anesthesia & Analgesia, 114(5), 1003- 1014.

The incidence of perioperative complications is greater in patients with obstructive sleep apnea (OSA).2

Liao, P., Yegneswaran, B., Vairavanathan, S. et al. Can J Anesth/J Can Anesth (2009) 56: 819. doi:10.1007/s12630-009-9190-y.

Sentinel events from respiratory depression are caused by wrong dosing 47% of the time and improper monitoring 29% of the time.3

Joint Commission. (2012). Sentinel Event Alert Issue 49: Safe use of opioids in hospitals. August 8, 2012.

68% of all failure-to-rescue deaths occur among surgical inpatients with treatable complications, pressure ulcers, post-operative respiratory failure, and post-operative sepsis.4

Reed and May, HealthGrades Patient Safety in American Hospitals Study, March 2011.

Approximately 25,000 potentially life-threatening errors occur daily in hospital intensive care units (ICUs), and up to 10 percent of these adverse events involve unintended incidents in Airway Management; more than half of these errors have been deemed preventable.5

Needham, D. M., Thompson, D. A., Holzmueller, C. G., Dorman, T., Lubomski, L. H., Wu, A. W., … & Pronovost, P. J. (2004). A system factors analysis of airway events from the Intensive Care Unit Safety Reporting System (ICUSRS). Critical Care Medicine, 32(11), 2227-2233.