From the Guidelines
Epistaxis and hemoptysis are potential complications of endotracheal intubation, but they are not typically common occurrences, and their likelihood can be minimized with careful preparation and anticipation of potential risks. When considering the risks associated with endotracheal intubation, it's essential to recognize that the procedure can be complicated by various factors, including the patient's underlying health conditions, the difficulty of the intubation itself, and the operator's experience 1.
Key Considerations
- The patient's overall health status, including conditions such as coagulopathy, use of blood thinners, or pre-existing nasal or oral injuries, can increase the risk of bleeding during intubation.
- Difficult intubation, defined by two or more attempts at endotracheal intubation, is regarded as a complication of the intubation procedure and can increase the risk of bleeding 1.
- The use of predictive scores, such as the MACOCHA score, can help identify patients at risk of difficult intubation, allowing for appropriate preparation and management strategies to be implemented 1.
Minimizing Risks
- Careful preparation for the intubation procedure, including assessment of the patient's airway and anticipation of potential complications, is crucial in minimizing the risk of bleeding 1.
- Maintaining oxygenation and cardiovascular stability throughout the procedure is also essential in reducing the risk of complications, including bleeding 1.
- The use of standardized intubation protocols and algorithms, adapted to the specific needs of each ICU, can help ensure that intubation procedures are performed safely and efficiently, with minimal risk of complications 1.
From the Research
Complications of Endotracheal Intubation
- Epistaxis (nosebleed) and hemoptysis (coughing up blood) are potential complications of endotracheal intubation 2
- Nasotracheal intubation, in particular, can lead to epistaxis due to damage to the Kiesselbach's plexus in the anterior part of the nasal septum 2
- Hemoptysis can also occur after tissue plasminogen activator (tPA) administration for stroke treatment, and tranexamic acid (TXA) may be used to control the bleeding 3
Use of Tranexamic Acid
- TXA is a synthetic anti-fibrinolytic agent that can be used to control bleeding in various clinical settings, including epistaxis and hemoptysis 4, 5, 3, 6
- TXA can be administered orally, intravenously, topically, or via inhalation, and has been shown to be effective in reducing the risk of re-bleeding in patients with epistaxis 4
- In cases of hemoptysis, TXA can be administered as a bolus through the bronchoscope or via inhalation, and has been shown to be effective in controlling severe bleeding 5, 6
Prevention of Complications
- Simple countermeasures, such as removing nasal dirt from the tip of the tracheal tube and cleaning the pharynx, can help prevent complications associated with nasotracheal intubation 2
- Prior treatment of nostrils and anterior nasal septum with mupirocin can also help prevent bacteraemia and carriage of bacteria into the trachea 2