Key points Among critically ill patients undergoing tracheal intubation worldwide, how common are major adverse events during the periintubation period? Findings In this prospective observational study that included 2964 patients from 197 sites in 29 countries from October 2018 to July 2019, at least one major clinical event occurred after intubation in 45.2% of patients, including cardiovascular instability in 42.6%, severe hypoxemia in 9.3%. and cardiac arrest in 3.1%. Meaning Among an international sample of critically ill patients undergoing tracheal intubation, major cardiopulmonary events occurred frequently. |
Importance
Tracheal intubation is one of the high-risk interventions most commonly performed in critically ill patients. Limited information is available on periintubation adverse events.
Aim
To evaluate the incidence and nature of periintubation adverse events and evaluate the current practice of intubation in critically ill patients.
Design, environment and participants
The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) was a prospective, multicenter, international cohort study that included consecutive critically ill patients undergoing tracheal intubation in the units. intensive care (ICU), 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 on the 5 continents.
Exhibitions
Tracheal intubation.
Main results and measures
The primary outcome was the incidence of major periintubation adverse events defined as at least one 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 increasing need for vasopressors or fluid bolus > 15 ml/kg).
- Severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest.
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) were included from 197 sites on all 5 continents.
- The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological deterioration in 30.5% and cardiovascular instability in 9.4%.
- Primary outcome data were available for all patients.
- Among study patients, 45.2% experienced at least one major adverse periintubation event.
- The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing urgent intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%).
- Overall mortality in the ICU was 32.8%.
Conclusions and relevance In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites in 29 countries, major periintubation adverse events, particularly cardiovascular instability, were frequently observed. |
