Intubated, Awake, and Paralysed: A Never Event

Authors

Huw Mayberry^1, , Alyssa M. Burgart^2, , Constantinos Kanaris^{3, *,}

¹Department of Paediatric Intensive Care, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

²Department of Anesthesiology, Stanford University School of Medicine, CA, US

³Department of Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

^*Corresponding author. Email: ckanaris@doctors.net.uk

DOI

10.2991/icres.k.211028.001How to use a DOI?

Keywords

Intubation; paralysis only intubation; awareness during resuscitation; awareness during intubation; awareness during CPR; awareness during anaesthesia; critical care; intensive care

Abstract

In this paper, we argue that paralysis-only intubation is almost never acceptable practice. We look at the evidence suggesting that this practice remains commonplace worldwide, its frequency has been exacerbated further by anaesthetic drug shortages secondary to the COVID-19 pandemic. We make a strong case that intubating a patient without sedation has such profound psychological and physiological risks that the practice is unethical and should be banned from medical practice with the exception of two clinical settings. These exceptions include (a) newborn intubation immediately after birth if there is immediate risk to life and (b) awake fibreoptic intubation whereby the patient has consented in advance, co-operative, and the airway has been prepared with local anaesthesia. We further argue that even in cases of cardiopulmonary resuscitation the practice impacts both on patient safety and clinician moral distress and as such in well-resourced times, there can be no justification for harming patients in this way. Formally labelling this practice as a Never Event is a way forward to homogeneously address the risks this archaic practice poses, both to our patients and to ourselves.

Copyright

© 2021 First Affiliated Hospital of Zhengzhou University. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Download article (PDF)
View full text (HTML)

TY  - JOUR
AU  - Huw Mayberry
AU  - Alyssa M. Burgart
AU  - Constantinos Kanaris
PY  - 2021
DA  - 2021/11/16
TI  - Intubated, Awake, and Paralysed: A Never Event
JO  - Intensive Care Research
SP  - 60
EP  - 64
VL  - 1
IS  - 3-4
SN  - 2666-9862
UR  - https://doi.org/10.2991/icres.k.211028.001
DO  - 10.2991/icres.k.211028.001
ID  - Mayberry2021
ER  -