(1074) Risk of Difficult Intubation in Critically Ill Adults With Diabetes Mellitus

Introduction: Diabetes mellitus (DM) has been historically associated with significantly increased risk for difficult intubation. However, this has not been assessed in the modern era of airway management or DM treatment. We investigated whether DM was independently associated with an increase in time from induction to tracheal intubation among critically ill adults.

Methods: We conducted a secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG). The study population included critically ill adults who underwent tracheal intubation in the emergency department (ED) or intensive care unit (ICU) of 11 U.S. hospitals. Individual randomized trials assessed a pre-intubation checklist, pre-intubation fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie versus a stylet. Our primary outcome was time from induction to successful intubation of the trachea. Secondary outcomes included first-pass intubation success, airway complications including operator-reported aspiration, heart rate < 40 bpm, systolic blood pressure < 80 mmHg, hypoxia < 90%, severe hypoxia < 80%, airway trauma, esophageal intubation, cardiac arrest, or in-hospital mortality.

Results: A total of 2654 patients were included in this analysis; 638 (24%) had DM. The mean time from induction of anesthesia to tracheal intubation was 169 seconds (SD 137s). DM was not associated with an increase in this time, with a difference of -4.4 seconds ([-17.2 to 8.3 seconds], p=0.50). Use of a video vs direct laryngoscope did not modify the relationship between DM and the time from induction to intubation (p-value for interaction 0.064). Additionally, DM was not associated with decreased first-pass intubation success (85.6% vs. 84.3%, p=0.46). An airway complication occurred during intubation in 1007 patients (37.9%). DM was not associated with complications during intubation (39.8% vs. 37.4%, p=0.52).

Conclusions: Among 2654 critically ill adults undergoing tracheal intubation in an ED or ICU, diabetes mellitus was not associated with the time from induction to intubation, the probability of successful intubation on the first attempt or the incidence of complications during intubation.