Impact of NAP4: An audit into airway management on a general ICU

INTRODUCTION. The NAP4 Project highlighted significant concerns in regards to the management of airway complications on Intensive Care Units (ICU)1. This audit assessed the compliance of out ICU to the NAP4 recommendations. METHODS. A prospective audit of ventilated patients on ICU. Data collection focused on the documentation of intubation, techniques used to confirm intubation and the continuous use of ETCO₂ in ventilated patients. In addition basic intubation boxes and the difficult airway equipment available was compared against the Difficult Airway Society (DAS) Guidelines. RESULTS. There were 46 patients included in the audit. The majority of patients were intubated on ICU (23), 9 in theatre, 7 in A&E, and 6 on the wards. Documentation of intubation and confirmatory test was poor, with only half (23) having complete documentation. Documented use of ETCO₂ was only recorded in 11 patients, 9 of which were from theatre. 80 % of patients had continuous use of ETCO₂ whilst ventilated. The basic intubation boxes did not contain a DAS recommended checklist. Items on the checklist, which were not found in the boxes, included NPAs, LMAs, tracheal tube introducers (bougie) and a malleable stylet. The difficult airway trolley did not have a DAS guideline checklist, reinforced or microlaryngeal tracheal tubes, a flexible fibreoptic laryngoscope, proseal laryngeal mask airways or a surgical cricothyroidotomy kit. CONCLUSIONS. This audit demonstrated poor documentation of intubation and use of ETCO₂ to confirm intubation. Compliance with continuous use of ETCO₂ monitoring was better; however fell short of the recommended standard of 100 %. Airway equipment was below recommended DAS standards.