CHEST Guidelines-Do-Not-Throw-the-Intubation-Checklist-Out-With-the

Do-Not-Throw-the-Intubation-Checklist-Out-With-the

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The document discusses the effectiveness of a written, verbally performed preintubation checklist compared to usual care during endotracheal intubation in critically ill adults. The study by Janz et al., conducted across five ICUs, included 267 patients and found no significant improvement in median lowest arterial oxygen saturation or systolic blood pressure using the checklist. Despite these findings, the commentary by Audrey De Jong and Samir Jaber emphasizes the importance of checklists in healthcare, particularly in critical situations like tracheal intubation, where careful planning and awareness of alternative strategies are crucial.<br /><br />The commentary suggests that while the checklist used in the study contained routine items, it lacked components that could improve physiological parameters, such as specific preoxygenation techniques and hemodynamic stabilization methods like fluid loading and vasopressors. This gap potentially limits the effectiveness of the checklist. Additionally, the study's setting in expert centers, a possible Hawthorne effect, and methodological limitations such as incomplete checklists and non-standardized procedures, may have affected the results.<br /><br />The authors argue for the continuation and improvement of checklists, particularly in less experienced centers or severe cases, by incorporating comprehensive and action-oriented items. They suggest that a large, multicenter, clustered randomized study involving various expertise levels and using a more extensive checklist could provide more definitive insights into their utility and effectiveness in enhancing patient safety and procedure outcomes during intubation.

Keywords

preintubation checklist

endotracheal intubation

critically ill adults

Janz et al.

ICUs study

oxygen saturation

systolic blood pressure

checklist effectiveness

healthcare checklists

intubation safety