6533b82cfe1ef96bd128f66b
RESEARCH PRODUCT
Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries
Russotto V.Myatra S. N.Laffey J. G.Tassistro E.Antolini L.Bauer P.Lascarrou J. B.Szuldrzynski K.Camporota L.Pelosi P.Sorbello M.Higgs A.Greif R.Putensen C.Agvald-ohman C.Chalkias A.Bokums K.Brewster D.Rossi E.Fumagalli R.Pesenti A.Foti G.Bellani G.Hazem Abdelkarem AhmedNeill K J AdhikariKehari AgrawalNipun AgrawalHernan Aguirre-bermeoChristina Agvald-öhmanMeraj AhmadSamareh AjamiShazia N AkhtarAdnan AlghamdiAbdulmueti AlhadiSyed M AliMohd N AliAnita AliasGhaleb AlmekhlafiJulio AlonsoDiana Alvarez MontenegroRubina AmanMatthew AnsteyIrene AragãoEleni ArnaoutoglouElie AzoulayLaura BaccariNishanth BaligaRamya Ballekatte ManjunathShrirang BamaneAnna BandertRoland BartholdyMarta BastoVera BaturovaPhilippe R BauerAgrippino BellissimaVladislav BelskyPrashant BendreAnnalisa BeniniSebastien BessetMahuya BhattacharyyaPiotr BielanskiLuca BigatelloFlorence BoissierKristaps BokumsElisa BoniIwona BonneyDavid BowenAlexandre BoyerLuca BrazziDavid BrewsterLina BromanAlexander BrowneCedric BruelYannick BruninGuillermo BugedoItalo CalamaiPatricia CamposFederico G CanavosioIacopo CappelliniMarco CascellaNuno CatorzeAthanasios ChalkiasBenoit ChampigneulleJuhi ChandwaniAnne ChaoSatish ChaurasiaRajesh ChawlaAakanksha ChawlaOlivia CheethamFrank ChemouniLee Chew KiokJung-yien ChienTimothy ChimundaChing-tang ChiuFernando ChiumientoNai-kuan ChouNicolas ChudeauSandra ColicaGwenhael ColinJean-michel ConstantinDamien ContouAndrea CortegianiPaulo F CostaVasco CostaAndrea CostamagnaAntonella CotoiaAndrea N CracchioloPetra CroneRui P CunhaRenata Curić RadivojevićAmit DasSampat DashGennaro De PascaleSilvia De RosaLorenzo Del SorboValentina Della TorreBarbara Di CaprioRaffaele Di FenzaIda Di GiacintoAikaterini DimitropoulouMarcel DuddaChristopher EdmundsStefan F EhrentrautNadia El-fellahMuhammed ElhadiAhmed ElhadiPatricia Escudero-achaMissael EspinozaClelia EspositoFabrizio FabrettiDaniel G FeinMassimo FerlugaMarco FernandesAlexis FerreJanet FerrierMarek FlaksaFernando FloresJesus Flores GonzalezXavier E Fonseca FuentesRoland FrancisDaniela G FrancoPawel FranczykJean-pierre FratMikhail FurmanMaurizio FusariPiotr GalkinAlice Gallo De MoraesRenato GammaldiMaria F García AguileraEugenio GarofaloTomasz GaszynskiJonathan GatwardMohamed GhulaAngelo GiacomucciIlaria GiovanniniKingsly GnanaduraiThomas GodetAlberto GoffiGemma Goma FernandezMaria GonzalezDaira GonzálezAlejandro González-castroKadarapura N GopalakrishnaEric GottesmanAlexandre GrosChristophe GuervillyChristophe GuittonManish GuptaKulbhusahn GuptaTarikul HamidOlfa HamzaouiKatrin HannesdottirShahnaz HasanMozaffer HossainSazzad HosseinSami HraiechChun-kai HuangCameron HypesSoad Imhmed AlkhumsiMotiul IslamMuhamad A IsmailVišnja IvančanSophie JacquierBharat JagiasiNikhilesh JainMuhamad Fadhil Hadi JamaluddinMilosz JankowskiDeepak JeswaniDeepti JeswaniSimant JhaLaura JonesBenjamin JonesMathieu JozwiakAleksandra JumićOliver KampIlias KarametosAlexey KarelovPanagiotis KatsoulisDavid A KaufmanShuchi KaushikCallum T KayeSubba R KesavarapuAla KhaledHapiz KhalidahAkram KhanSudhir KhuntetaDetlef Kindgen-millesSara V KorulaAmol KothekarSalman S KoulDitte KrogShih-chi KuMira KuellmarLu-cheng KuoSwarna D KuragayalaAikaterini KyparissiGonzalo LabarcaJohn G LaffeyJaya LalwaniAntonio LandaverdeJean-baptiste LascarrouAndres LasernaChien-chang LeeStephane LegrielAndrew LehrTiago LeonorYongxing LiAnna Lisa LicciardiEdward LittonVladimir LomivorotovFederico LonghiniClaudia L Lopez NavaLuis R Loza GallardoRamona LunguAnnalisa LuziWuhua MaMarat MagomedovAlexandros MakrisHarish Mallapura MaheshwarappaTommaso MaraffiMaria E MarcelliKarim MarianoNathalie MarinNadezhda MarovaMaelle MartinMayra Martinez GonzalezEmilio MasedaFiore MastroianniMarijana MatasDubier MatosJessica G MaugeriMohd Z MazlanMelanie MeerschRanjan MeherTasneem H MehesryMaria MeirikArmand Mekontso DessapKwabena MensahEmmanuelle MercierPavel MichalekAbhirup MidyaSlobodan MihaljevićAdrien MirousePrasanna MishraRavi MistryMate MogušNorbaniza Mohd NordinNoryani Mohd SamatLuca MontiniGiorgia MontrucchioValeria MoroDiego Morocho TutilloJarrod MosierSircar MrinalWojciech MudynaGrégoire MullerKartik MuntaSatheesh MunusamyStefania MussoStefano MuttiniIsmail Nahla IrtizaEvi NakouAmit NarkhedeJoseph NatesMoana R NespoliFrancesca NespoliArtem NikitenkoCarla NogueiraRoss O'gradyYewande E OdeyemiAnnika OhlssonAlberto OrselloVijayanand PalaniswamyDaniela M PalmaSalvatore PalmeseJesus N Pantoja LealEleni PapandreouMetaxia PapanikolaouMatteo ParottoMayur PatelMario PavlekNiccolò PedrottiNgu Pei HwaLorella PelagalliMiryam Pérez RuizElin PerssonAthanasia PetsiouAngelo PezziSam PhilipFrancois PhilippardMariusz PiegatSébastien Pili-flouryRiccardo PinciroliMarcia PintoGael PitonGaetan PlantefeveCaroline PoupletSofia PourikiAndrea PradellaKumar PrashantChristian PutensenAlice QuayleLua RahmaniIan RandallBanambar RayAdrian RegliSyed T RezaJean Damien RicardIvano RivaOriol RocaRoberto RonaJon RosellRebecca RowleySheng-yuan RuanKay RumschuesselAnnalisa RundoPierpaolo RussoVincenzo RussottoSamir SahuGabriele SalesCharlotte Salmon-gandonnièreNandyelly San Juan RomanLuis Sánchez-hurtadoBenjamin J SandefurManel SantafeLida SantoroRhik SanyalLakshmikanthcharan SaravanabavanBhagyesh ShahMehul ShahMing-hann ShinMonica SilvaShannon SimpsonAyush SinahAtul K SinghDinesh K SinghNitesh SinghLalit SinghLukasz SkowronskiMiguel A SosaSavino SpadaroMartin SpangforsJesper SperberRosario SpinaAnand SrivastavaAndrew SteelAlejandro Suarez De La RicaSingh Sujeet KumarOmprakash SundraniNilu SunilBharadwaj SuparnaManimala R SurathYadullah SyedTamas SzakmanyBenjamin SztrymfAlexis TabahStefano TarantinoMaria TileliHugo Tirape-castroOtoniel Toledo-salinasJacopo TramarinDimitrios TsiftsisIva TucićJose A Tutillo LeónLorenzo TutinoVijay N TyagiKyriaki VagdatliSneha VarkeyMaria M VeraMagnus Von SethCarl WahlstromWan Mohd N Wan HassanWan N Wan IsmailKuo-chuan WangHadrien WiniszewskiJiayan WuLun WuYu-chang YehPaul YoungGianluca ZaniJonathan ZarkaDawn ZhaoDiane Zlotniksubject
Malemedicine.medical_specialtyCritical Illnessmedicine.medical_treatmentAged; Critical Illness; Female; Heart Arrest; Humans; Hypotension; Hypoxia; Intensive Care Units; Intubation Intratracheal; Logistic Models; Male; Medical Errors; Middle Aged; Prospective Studies; Respiration Artificial; Respiratory Insufficiency; Vasoconstrictor Agents01 natural sciencesNOtracheal intubation ; adverse peri-intubation events03 medical and health sciences0302 clinical medicineInterquartile rangeIntensive careSettore MED/41 - ANESTESIOLOGIAIntubation IntratrachealHumansVasoconstrictor AgentsMedicineIntubationIntubation Critical CareProspective Studies030212 general & internal medicine0101 mathematics610 Medicine & healthHypoxiaProspective cohort studyAgedMedical Errorsbusiness.industryRespiration010102 general mathematicsTracheal intubationGeneral MedicineMiddle AgedRespiration ArtificialHeart ArrestIntratrachealIntensive Care UnitsIntubation procedureLogistic ModelsRespiratory failureArtificialEmergency medicineFemaleAirway managementHypotensionIntubationRespiratory Insufficiencybusinessdescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-03-23 |