TY - JOUR
T1 - Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients from 29 Countries
AU - INTUBE Study Investigators
AU - Russotto, Vincenzo
AU - Myatra, Sheila Nainan
AU - Laffey, John G.
AU - Tassistro, Elena
AU - Antolini, Laura
AU - Bauer, Philippe
AU - Lascarrou, Jean Baptiste
AU - Szułdrzyński, Konstanty
AU - Camporota, Luigi
AU - Pelosi, Paolo
AU - Sorbello, Massimiliano
AU - Higgs, Andy
AU - Greif, Robert
AU - Putensen, Christian
AU - Agvald-Öhman, Christina
AU - Chalkias, Athanasios
AU - Bokums, Kristaps
AU - Brewster, David
AU - Rossi, Emanuela
AU - Fumagalli, Roberto
AU - Pesenti, Antonio
AU - Foti, Giuseppe
AU - Bellani, Giacomo
N1 - Funding Information:
Funding/Support: This study was funded and
Funding Information:
reported receiving personal fees from Baxter Healthcare and institutional grants from Science Foundation Ireland. Dr Lascarrou reported receiving personal fees from Becton, Dickinson, and Co and Zoll. Dr Sorbello reported receiving personal fees from Teleflex Medical, Merck Sharp & Dohme, Verathon Medical, and other support from Deas Italia (patent coowner no royalties) outside the submitted work. Dr Putensen reported receiving grants from the German Research Foundation Electric Impedance Tomography outside the submitted work. Dr Pesenti reported receiving personal fees from Maquet, Novalung-Xenios, Baxter, and Boehringer Ingelheim. Dr Bellani reported receiving grants from Draeger Medical and personal fees from Dimar, Draeger Medical, Getinge, Flowmeter, Hamilton, and GE Healthcare and having a patent pending for a system for noninvasive ventilation. No other disclosures were reported.
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3/23
Y1 - 2021/3/23
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85103037766&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85103037766&partnerID=8YFLogxK
U2 - 10.1001/jama.2021.1727
DO - 10.1001/jama.2021.1727
M3 - Article
AN - SCOPUS:85103037766
VL - 325
SP - 1164
EP - 1172
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0002-9955
IS - 12
ER -