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Effect of Endotracheal Intubation Performed by Trauma Surgeons on Patientswith Severe Traumatic Brain Injury: A Prospective Observational Cohort Study

Liang Wang1, Xu-rui Shen2, Feng Xu1, Wei-hua Ling1, Xiong-hui Chen1*

Background: The patients with severe trauma traumatic brain injury (STBI) should be intubated as early as possible, and most of the intubation was performed by anesthesiologists. With the construction of trauma centers in China, more and more trauma surgeons have mastered endotracheal intubation skills after standardized training, more and more trauma patients were intubated by trauma surgeons. We undertook a prospective observational cohort study of endotracheal intubation in emergency resuscitation room to study the effect of endotracheal intubation respectively performed by trauma surgeons and anesthesiologists on patients with STBI.

Methods: We collected data of all intubated patients with STBI between January 2018 and March 2020. Patients were divided into trauma surgeons, intubation (TI) group and anesthesiologists, intubation (AI) group according to intubation performer. We recorded age, gender, GCS, ISS, admission RR, admission HR, admission SpO2, admission PO2, admission PCO2, admission SBP, mechanism of injury, type of intracranial lesion, endotracheal intubation time, 1-min success rate of intubation, intubation related complications, the time from arrival at hospital to intubation, incidence of aspiration pneumonia, mechanical ventilation time, 30-day mortality. Comparison was made between the two groups.

Results: Among 356 STBI patients, 219 patients met the inclusion criteria (TI group N=142, AI group N=77). There were no significant statistical differences between the groups in age, gender, GCS, ISS, admission RR, admission HR, admission SpO2, admission PO2, admission PCO2, admission SBP, mechanism of injury, type of intracranial lesion. There were also no significant statistical differences between the groups in endotracheal intubation time, 1-min success rate of intubation and intubation related complications. The time from arrival at hospital to intubation in the TI group significantly lower than the AI group (p<0.01). Compared with the AI group, the incidence of aspiration pneumonia and the mechanical ventilation time were decrease (p<0.05). 30-day mortality had no significant statistical difference between the groups.

Conclusion: The trauma surgeons can master endotracheal intubation skills through standardized training, and the intubation effect is not significantly different from that of anesthesiologists. Moreover, endotracheal intubation by trauma surgeons allow the patients with STBI to be intubated earlier and reduce the incidence of aspiration pneumonia and the mechanical ventilation time. So early intubation is beneficial for the patients with STBI, and trauma surgeons should be encouraged to master endotracheal intubation skills.