What Is Rapid Intubation?

Rapid intubation, also known as rapid sequence intubation (RSI), is a technique used in emergency settings to rapidly secure airway access, if it appears to be indicated. Special training is necessary to assess patients to determine if this treatment is appropriate, and to perform it quickly and accurately. In a situation where a patient's airway is already compromised and the brain is not getting enough oxygen, other measures may be more appropriate.

In this procedure, a care provider oxygenates the patient first, and then administers a strong sedative and paralytic to render the patient unconscious and relaxed. This makes it possible to quickly and accurately perform an endotracheal intubation to gain access to the airway, relying on the earlier oxygenation to prevent hypoxia. The rapidity of the procedure eliminates the need to perform bag valve mask ventilation while the patient is unconscious, which reduces the risk that the patient will aspirate on the stomach contents.

Emergencies can result in rapidly changing situations, where airway access may become critical. If a patient's airway is already compromised or there are concerns about the risk of a difficult intubation, rapid intubation may not be recommended because it could put the patient at risk. A care provider must decide on the best approach to airway management, given the circumstances and what is known of the patient's history. One problem with emergencies is that patient history is often incomplete or unavailable; for example, paramedics may not know when the patient last ate, which is why there are concerns about aspiration.

This procedure should be reasonably comfortable for the patient, who will be unconscious for most of it. Once the airway is secure after a rapid intubation, additional steps can be taken to provide appropriate treatment and interventions. These may include moving a patient to surgery, in which case an anesthesiologist will take over management of the airway and can administer paralytic and sedative drugs appropriate to the patient's needs.

There can be risks to rapid intubation. In any medical procedure, care providers weigh the benefits against the possible risks to determine the best course of action. Extensive training allows people to make the best split second decisions possible with the available information. In the event of a poor patient outcome after rapid intubation, a morbidity and mortality presentation may discuss what happened, explore why, and provide information on how to prevent future incidents of a similar nature. Such presentations can provide valuable learning experiences for clinicians so they do not repeat the mistakes of their colleagues.