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

Russotto, Vincenzo ; Nainan Myatra, Sheila ; Laffey, John G. ; Tassistro, Elena ; Antolini, Laura ; Bauer, Philippe ; Lascarrou, Jean Baptiste ; Szuldrzynski, Konstanty ; Camporota, Luigi and Bellani, Giacomo (2021) In JAMA: The Journal of the American Medical Association 325(12). p.1164-1172
Abstract
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,... (More)
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. (Less)
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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
JAMA: The Journal of the American Medical Association
volume
325
issue
12
pages
1164 - 1172
publisher
American Medical Association
external identifiers
  • pmid:33755076
  • scopus:85103037766
ISSN
0098-7484
DOI
10.1001/jama.2021.1727
language
English
LU publication?
yes
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d491abcc-76bc-471f-9b4e-1716142b80d5
date added to LUP
2021-05-26 21:00:36
date last changed
2023-03-24 19:53:36
@article{d491abcc-76bc-471f-9b4e-1716142b80d5,
  abstract     = {{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 &lt;65 mm Hg at least once, &lt;90 mm Hg for &gt;30 minutes, new or increase need of vasopressors or fluid bolus &gt;15 mL/kg), severe hypoxemia (peripheral oxygen saturation &lt;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.}},
  author       = {{Russotto, Vincenzo and Nainan Myatra, Sheila and Laffey, John G. and Tassistro, Elena and Antolini, Laura and Bauer, Philippe and Lascarrou, Jean Baptiste and Szuldrzynski, Konstanty and Camporota, Luigi and Bellani, Giacomo}},
  issn         = {{0098-7484}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{1164--1172}},
  publisher    = {{American Medical Association}},
  series       = {{JAMA: The Journal of the American Medical Association}},
  title        = {{Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries}},
  url          = {{http://dx.doi.org/10.1001/jama.2021.1727}},
  doi          = {{10.1001/jama.2021.1727}},
  volume       = {{325}},
  year         = {{2021}},
}