NAP4 was a national audit by the Royal College of Anaesthetists and the Difficult Airway Society that gathered the major complications of airway management in the UK. Its second part (Cook et al., British Journal of Anaesthesia 2011) analyzed what happened in intensive care and emergency departments.
What it found
| Finding | Data |
|---|---|
| Capnography and serious outcome | Its absence contributed to 74% of cases of death or persistent neurological injury in ICU and emergency departments |
| Where events happen | At least 1 in 4 major in-hospital airway events occurs in ICU or the emergency department |
| Prevention | Most emergency department events could have been prevented with better systems, preparation and communication |
Follow-up
A later audit in the ICU of a district general hospital found that only 27% of intubated patients had continuous capnography, and noted that NAP4 recommends it for all intubations and for ventilated patients with a tracheal tube or tracheostomy in ICU.
Sources
- Cook TM, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011;106(5):632-642. doi:10.1093/bja/aer059
- PubMed · article abstract
- Audit of airway complications in a district general hospital ICU (PMC)
Image: Airway Zen program simulation.
Educational content; it does not replace clinical judgment or your institution's guidelines.