Endotracheal Intubation Outside of the Intensive Care Unit During Rapid Response Activations

Tuesday, March 24, 2026

8:45 AM - 9:45 AM Central Time

Location: Connections Central - RST 11

KS

Kipp Shipley, DNP, APRN

Vanderbilt University

Disclosure(s): No relevant financial relationship(s) to disclose.
Megan Shifrin, DNP, ACNP, FAANP

Vanderbilt University, Tennessee

Disclosure(s): No relevant financial relationship(s) to disclose.
JF

Jennifer Fitzsimmons, ACNP, MSN, RN

Nurse Practitioner, Critical Care Outreach Team
Vanderbilt University Medical Center

Disclosure information not submitted.
VK

Victoria Kramer, PA-C

Nurse Practitioner, Critical Care Outreach Team
Vanderbilt University Medical Center

Disclosure information not submitted.
CS

Connor Snarskis, MD

Assistant Professor of Anesthesiology
Vanderbilt University Medical Center

Disclosure information not submitted.
LW

LIZA WEAVIND, MD, FCCM, MBBCh

Professor of Anesthesiology & Surgery
Vanderbilt University Medical Center

Disclosure information not submitted.

Introduction: Critically-ill adult patients requiring rapid response team (RRT) activation often present with acute hypoxia, acute hypercapnia, or the inability to protect their airway necessitating emergent endotracheal intubation (ETI) prior to intensive care unit (ICU) transfer. The purpose of this study is to identify patient morbidity and mortality outcomes associated with ETI outside of the ICU during RRT activations at a large academic medical center in the Southeastern United States.

Methods: Non-ICU ETIs during RRT activations were reviewed for a two year period (June 01, 2023-June 30, 2025) to identify 1) the indication for ETI; 2) immediate complications during ETI (conversion to surgical airway or cardiac arrest); 3) vasopressor infusion use within 2 hours following ETI; 4) hospital mortality; 5) duration of mechanical ventilation (DMV) ; as well as 6) ICU and hospital length of stay (LOS) in patients surviving to discharge. We defined indications for ETI as 1) hypoxia with Sp02 < 92% despite supplemental oxygen support, 2) hypercapnia with pCO2 > 70 mmHg, and 3) inability to protect airway as defined by bedside clinicians.

Results: During the study period, 80 patients required ETI due to indications of hypoxia (n=28), hypercapnia (n=10), and inability to protect airway (n=42). Immediate complications occurred in 7.5% (n=6) of patients requiring ETI, and circulatory shock requiring vasopressor support occurred in 51.3% (n=41) of patients within 2 hours of ETI. During the study period, overall hospital mortality rates in our patient population were 47.5% (n=38) for clinical deterioration requiring intubation during a rapid response activation. In patients surviving to discharge, the average length of mechanical ventilation was 3.87 days, average ICU LOS was 6.58 days, and average hospital LOS was 27 days.

Conclusions: ETI in critically ill adult patients outside of the ICU is often a surrogate for ongoing clinical deterioration during admission. In our retrospective, descriptive study we found that altered mental status was one of the most common indications for ETI outside of the ICU. Over half of our population developed subsequent circulatory shock requiring vasopressor support and our hospital mortality rates were expectedly elevated.