Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries

IMPORTANCE: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. OBJECTIVE: To evaluate the incidence and nature of adverse peri-intubation events and to assess current pr...

Full description

Saved in:

Bibliographic Details
Published in:	JAMA : the journal of the American Medical Association Vol. 325; no. 12; pp. 1164 - 1172
Main Authors:	Russotto, Vincenzo, Myatra, Sheila Nainan, Laffey, John G, Tassistro, Elena, Antolini, Laura, Bauer, Philippe, Lascarrou, Jean Baptiste, Szuldrzynski, Konstanty, Camporota, Luigi, Pelosi, Paolo, Sorbello, Massimiliano, Higgs, Andy, Greif, Robert, Putensen, Christian, Agvald-Öhman, Christina, Chalkias, Athanasios, Bokums, Kristaps, Brewster, David, Rossi, Emanuela, Fumagalli, Roberto, Pesenti, Antonio, Foti, Giuseppe, Bellani, Giacomo
Format:	Journal Article
Language:	English
Published:	United States American Medical Association 23-03-2021
Subjects:	Aged Anestesi och intensivvård Anesthesiology and Intensive Care Best practice Blood pressure Caring for the Critically Ill Patient Clinical Medicine Continents Critical Illness - mortality Critical Illness - therapy Emergency medical care Emergency medical services Female Heart Heart Arrest - etiology Hospitals Humans Hypotension - etiology Hypoxemia Hypoxia - etiology Instability Intensive care Intensive Care Units Intubation Intubation, Intratracheal - adverse effects Intubation, Intratracheal - methods Klinisk medicin Logistic Models Male Medical and Health Sciences Medical Errors - statistics & numerical data Medicin och hälsovetenskap Mercury Middle Aged Mortality Neurological complications Original Investigation Oxygen content Prospective Studies Respiration, Artificial Respiratory failure Respiratory Insufficiency - therapy Stability Systolic pressure Vasoconstrictor Agents - therapeutic use
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	IMPORTANCE: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. OBJECTIVE: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. EXPOSURES: Tracheal intubation. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. RESULTS: Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%. CONCLUSIONS AND RELEVANCE: In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events—in particular cardiovascular instability—were observed frequently.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	0098-7484 1538-3598 1538-3598
DOI:	10.1001/jama.2021.1727