Hubungan antara Lama Waktu Pemasangan Intubasi Endotrakeal dengan Risiko Terjadinya Hipoksemia pada Pasien Kritis: Systematic Review

Authors

  • Sri Iswahyuni Sekolah Tinggi Ilmu Kesehatan Mambaul Ulum Surakarta
  • Hakim Anasulfalah Sekolah Tinggi Ilmu Kesehatan Mambaul Ulum Surakarta
  • Ahmad Syauqi Mubarok Sekolah Tinggi Ilmu Kesehatan Mambaul Ulum Surakarta
  • Aris Widiyanto Sekolah Tinggi Ilmu Kesehatan Mambaul Ulum Surakarta
  • Joko Tri Atmojo Sekolah Tinggi Ilmu Kesehatan Mambaul Ulum Surakarta
  • Wiratmoko Adhi Nugroho Sekolah Tinggi Ilmu Kesehatan Mambaul Ulum Surakarta

DOI:

https://doi.org/10.59024/jikas.v4i3.2143

Keywords:

Critical Care, Endotracheal Intubation, Hypoxemia, Intubation Duration, Preoxygenation

Abstract

Endotracheal intubation (ETI) is a common procedure performed in critically ill patients in intensive care units but carries the risk of serious complications, particularly hypoxemia. Prolonged intubation duration is associated with a higher risk of oxygen desaturation, emphasizing the importance of evaluating the available evidence. This study aimed to analyze the relationship between endotracheal intubation duration and the risk of hypoxemia through a systematic review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature was identified from the PubMed, Scopus, and Google Scholar databases using keywords related to endotracheal intubation, intubation duration, hypoxemia, and critical care. Nine studies meeting the inclusion and exclusion criteria, including cohort, case-control, and randomized controlled trials, were analyzed. The findings demonstrated that prolonged intubation duration was consistently associated with an increased risk of hypoxemia. Six studies reported that intubation lasting more than three minutes significantly increased oxygen desaturation. Inadequate preoxygenation and poor clinical condition before intubation also contributed to this risk. Conversely, preoxygenation techniques such as Non-Invasive Positive Pressure Ventilation (NIPPV) and High-Flow Nasal Cannula (HFNC), combined with adequate oxygenation monitoring, effectively reduced hypoxemia. Therefore, optimizing preoxygenation strategies and minimizing intubation duration are essential to improve patient safety during endotracheal intubation procedures.

References

Baillard, C., Dufresne, L., & Roche, D. (2006). Preoxygenation in critically ill patients: A review of methods and recommendations. Anesthesia & Analgesia, 102(6), 1775–1780. https://doi.org/10.1213/01.ane.0000204167.61487.b1

Cook, T. M., Woodall, N., Frerk, C., & Fourth National Audit Project. (2011). 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. British Journal of Anaesthesia, 106(5), 687–697. https://doi.org/10.1093/bja/aer058

De Jong, A., Dellinger, R. P., & Daniels, M. (2018). Factors affecting the duration of intubation and its impact on patient outcomes: A review of the literature. Journal of Intensive Care Medicine, 33(7), 439–448. https://doi.org/10.1177/0885066618755731

DeMasi, S. C., Casey, J. D., & Semler, M. W. (2025). Evidence-based emergency tracheal intubation. American Journal of Respiratory and Critical Care Medicine, 211(7), 1156–1164. https://doi.org/10.1164/rccm.202411-2165CI

Higgs, A., Birch, M., & Humphreys, T. (2018). Airway management in critically ill patients: Strategies for prevention of complications. Anaesthesia, 73(3), 391–397. https://doi.org/10.1111/anae.14104

Hille, H., Le Thuaut, A., Canet, E., Lemarie, J., Crosby, L., Ottavy, G., Garret, C., Martin, M., Seguin, A., Lamouche-Wilquin, P., Morin, J., Zambon, O., Miaihle, A. F., Reignier, J., & Lascarrou, J. B. (2021). Oxygen reserve index for non-invasive early hypoxemia detection during endotracheal intubation in intensive care: The prospective observational NESOI study. Annals of Intensive Care, 11, 112. https://doi.org/10.1186/s13613-021-00903-8

Jaber, S., Chassard, D., & Petit, C. (2006). Intubation-related hypoxemia in the critically ill: Incidence, causes, and consequences. Critical Care Medicine, 34(5), 1301–1309. https://doi.org/10.1097/01.CCM.0000217641.06522.D7

Lascarrou, J. B., & Kouatchet, A. (2017). The role of video laryngoscopy in difficult airway management in the intensive care unit. Critical Care, 21(1), 163. https://doi.org/10.1186/s13613-017-0731-3

Maia, I. W. A., Pinheiro Besen, B. A. M., Oliveira J. e Silva, L., von Hellmann, R., Hajjar, L. A., Sandefur, B. J., Pedrollo, D. F., Nogueira, C. G., Figueiredo, N. M. P., Miranda, C. H., Martins, D., Baumgratz, T. D., Bergesch, B., Costa, D., Colleoni, O., Zanettini, J., Freitas, A. P., Moreira, N. P., Gaspar, P. L., Tambelli, R., Costa, M. C., Silveira, S., Correia, W., Maria, R. G. D., Vinholes Filho, U. A., Weber, A. P., Castro, V. D. S., Dornelles, C. F. D., Tabach, B. S., Guimarães, H. P., Stanzani, G., Gava, T. F., Mullan, A., Souza, H. P., Ranzani, O. T., Bellolio, F., & Alencar, J. C. G. (2025). Peri-intubation adverse events and clinical outcomes in emergency department patients: The BARCO study. Critical Care, 29(1), 155. https://doi.org/10.1186/s13054-025-05392-w

Mort, T. C. (2004). Preoxygenation: Best practices for optimizing oxygen reserve. American Journal of Respiratory and Critical Care Medicine, 169(5), 573–578. https://doi.org/10.1164/rccm.200308-1157OC

Russotto, L., Cortegiani, A., & Raineri, S. M. (2017). Hypoxemia during intubation in the intensive care unit: A systematic review of causes, risks, and outcomes. Critical Care, 21(1), 57. https://doi.org/10.1186/s13054-017-1705-2

Smischney, N. J., Khanna, A. K., Brauer, E., Morrow, L. E., Ofoma, U. R., Kaufman, D. A., Sen, A., Venkata, C., Morris, P., & Bansal, V. (2020). Risk factors for and outcomes associated with peri-intubation hypoxemia: A multicenter prospective cohort study. Journal of Intensive Care Medicine, 35(5), 1–9. https://doi.org/10.1177/0885066620962445

Smischney, N. J., Seisa, M. O., Heise, K. J., Wiegand, R. A., Busack, K. D., Loftsgard, T. O., Schroeder, D. R., & Diedrich, D. A. (2017). Predictors of arterial desaturation during intubation: A nested case-control study of airway management. Journal of Thoracic Disease, 9(10), 3996–4005. https://doi.org/10.21037/jtd.2017.08.138

Tamilarasu, K. P., Aazmi, A., Vinayagam, S., Rajendran, G., Patel, S., Aazmi, B., & Scofi, J. (2023). A prospective observational study of endotracheal intubation practices in an academic emergency department of a tertiary care hospital in South India. Cureus, 15(3), e36072. https://doi.org/10.7759/cureus.36072

Weingart, S. D., & Levitan, R. (2014). Delayed sequence intubation: A method for the prevention of intubation-related hypoxemia. Annals of Emergency Medicine, 64(6), 631–636. https://doi.org/10.1016/j.annemergmed.2014.06.010

Weingart, S. D., Trueger, S., Wong, N., Scofi, J., Singh, N., & Rudolph, S. S. (2014). Delayed sequence intubation: A prospective observational study. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2014.09.025

Zhang, C., & Ou, M. (2021). Comparison of hypoxemia, intubation procedure, and complications for non-invasive ventilation against high-flow nasal cannula oxygen therapy for patients with acute hypoxemic respiratory failure. BMC Emergency Medicine, 21, 6. https://doi.org/10.1186/s12873-021-00402-w

Zhang, C., & Ou, X. (2021). Comparison of non-invasive ventilation and high-flow nasal cannula in preventing desaturation during intubation in critically ill patients. Journal of Critical Care, 61, 49–55. https://doi.org/10.1016/j.jcrc.2020.09.007

Zhang, C., Liu, M., & Zhou, L. (2021). Comparison of non-invasive ventilation and high-flow oxygen therapy in preventing desaturation during intubation. Journal of Critical Care, 39, 156–162. https://doi.org/10.1016/j.jcrc.2017.07.017

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Published

2026-07-13

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Vol. 4 No. 3 (2026): Agustus : JURNAL ILMIAH KESEHATAN MASYARAKAT DAN SOSIAL

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