The use of a neuromuscular blocking agent before tracheal intubation can improve the odds of first-attempt intubation success in ICU patients.

“The question of whether to paralyze or not to paralyze is clearly answered in the operating room and emergency department: Using a paralytic is the way to go if you want to increase your first-attempt success at intubation,” said Jarrod M. Mosier, MD, an assistant professor of medicine and emergency medicine at the University of Arizona, Tucson. “However, we don’t know if this is true in the ICU as well.

“We also know that ICU patients are very different from those in the other two arenas. They’re sicker, and often times the people intubating them are not as experienced as in the other two venues when it comes to tracheal intubation.”

To help get a handle on the potential risks and rewards associated with intubating ICU patients, Dr. Mosier and his colleagues enrolled 664 consecutive patients into the observational study. Intubation-related data were collected prospectively on all patients intubated in the ICU over the study period, and then analyzed.

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