Vincenzo Russotto1,2, Sheila Nainan Myatra3, John G Laffey4,5, Elena Tassistro1,6, Laura Antolini1,6, Philippe Bauer7, Jean Baptiste Lascarrou8, Konstanty Szuldrzynski9, Luigi Camporota10, Paolo Pelosi11, Massimiliano Sorbello12, Andy Higgs13, Robert Greif14,15, Christian Putensen16, Christina Agvald-Öhman17, Athanasios Chalkias18, Kristaps Bokums19, David Brewster20,21, Emanuela Rossi1,6, Roberto Fumagalli1,22, Antonio Pesenti23, Giuseppe Foti1,2, Giacomo Bellani1,2. 1. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 2. Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy. 3. Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. 4. Regenerative Medicine Institute at CURAM Centre for Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland. 5. Anesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland. 6. Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy. 7. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. 8. Médecine Intensive Réanimation, University Hospital Center, Nantes, France. 9. Department of Interdisciplinary Intensive Care, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland. 10. Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 11. Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. 12. Anesthesia and Intensive Care, Policlinico Vittorio Emanuele San Marco University Hospital, Catania, Italy. 13. Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom. 14. Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland. 15. School of Medicine, Sigmund Freud University Vienna, Vienna, Austria. 16. Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany. 17. Anaesthesiology and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden. 18. University Hospital of Larissa, Larissa, Greece. 19. University Hospital Duesseldorf, Duesseldorf, Germany. 20. Intensive Care Unit, Cabrini Hospital, Malvern, Victoria, Australia. 21. Central Clinical School, Monash University, Clayton, Victoria, Australia. 22. Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 23. Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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 <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.
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.
Authors: Jarrod M Mosier; Joshua Malo; John C Sakles; Cameron D Hypes; Bhupinder Natt; Linda Snyder; James Knepler; John W Bloom; Raj Joshi; Kenneth Knox Journal: Ann Am Thorac Soc Date: 2015-04
Authors: Emma J Perkins; Jonathan L Begley; Fiona M Brewster; Nathan D Hanegbi; Arun A Ilancheran; David J Brewster Journal: PLoS One Date: 2022-10-20 Impact factor: 3.752
Authors: Gerald Matchett; Irina Gasanova; Christina A Riccio; Dawood Nasir; Mary C Sunna; Brian J Bravenec; Omaira Azizad; Brian Farrell; Abu Minhajuddin; Jesse W Stewart; Lawrence W Liang; Tiffany Sun Moon; Pamela E Fox; Callie G Ebeling; Miakka N Smith; Devin Trousdale; Babatunde O Ogunnaike Journal: Intensive Care Med Date: 2021-12-14 Impact factor: 41.787
Authors: Erin M Vaughan; Kevin P Seitz; David R Janz; Derek W Russell; James Dargin; Derek J Vonderhaar; Aaron M Joffe; Jason R West; Wesley H Self; Todd W Rice; Matthew W Semler; Jonathan D Casey Journal: J Intensive Care Med Date: 2021-12-13 Impact factor: 2.889