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

医学插管四分位间距重症监护气管插管麻醉不利影响呼吸衰竭气道管理急诊医学重症监护医学入射（几何）重症监护室外科内科学物理光学

作者

Vincenzo Russotto,Sheila Nainan Myatra,John G. Laffey,Elena Tassistro,Laura Antolini,Philippe R. Bauer,Jean-Baptiste Lascarrou,Konstanty Szułdrzyński,Luigi Camporota,Paolo Pelosi,Massimiliano Sorbello,A. Higgs,Robert Greif,Christian Putensen,Christina Agvald‐Öhman,Athanasios Chalkias,Kristaps Bokums,David Brewster,Emanuela Rossi,Roberto Fumagalli,Antonio Artigas,Giuseppe Foti,Giacomo Bellani,Hazem Ahmed,Neill K. J. Adhikari,Kehari Agrawal,Nipun Agrawal,Hernán Aguirre-Bermeo,Christina Agvald‐Öhman,Meraj Ahmad,Samareh Ajami,Shazia N. Akhtar,Adnan Alghamdi,Abdulmueti Alhadi,Syed Muhammad Adnan Ali,Mohd N. Ali,Anita Alias,Ghaleb A. Almekhlafi,Julio Alonso,Diana Alvarez Montenegro,Rubina Aman,Matthew Anstey,Irene Aragão,Eleni Αrnaoutoglou,Élie Azoulay,Laura Baccari,Nishanth Baliga,Ramya Ballekatte Manjunath,Shrirang Bamane,Anna Bandert,Roland Bartholdy,Marta Lima Basto,Vera Baturova,Philippe R. Bauer,Agrippino Bellissima,Vladislav Belsky,Prashant Bendre,Annalisa Benini,Sébastien Besset,Mahuya Bhattacharyya,Piotr Bielański,Luca M. Bigatello,Florence Boissier,Kristaps Bokums,Elisa Boni,Iwona Bonney,David Bowen,Alexandre Boyer,Luca Brazzi,David Brewster,Lina Broman,Alexander J. Browne,Cédric Bruel,Yannick Brunin,Guillermo Bugedo,Italo Calamai,Patricia Campos,Federico Giovanni Canavosio,Iacopo Cappellini,Marco Cascella,Nuno Catorze,Athanasios Chalkias,Benoît Champigneulle,Juhi Chandwani,Anne Chao,Satish Chaurasia,Rajesh Chawla,Aakanksha Chawla,Olivia Cheetham,Frank Chemouni,Lee Chew Kiok,Jung‐Yien Chien,Timothy Chimunda,Ching‐Tang Chiu,Fernando Chiumiento,Nai‐Kuan Chou,Nicolas Chudeau,Sandra Colica,Gwenhaël Colin,Jean‐Michel Constantin,Damien Contou,Andrea Cortegiani,Paulo F. Costa,Vasco Costa,Andrea Costamagna,Antonella Cotoia,Andrea Cracchiolo,Petra Crone,Rui Pedro Cunha,Renata Curić Radivojević,Amit Kumar Das,Sampat Dash,Gennaro De Pascale,Silvia De Rosa,Lorenzo Del Sorbo,Valentina Della Torre,Barbara Di Caprio,Raffaele Di Fenza,Ida Di Giacinto,Aikaterini Dimitropoulou,Marcel Dudda,Christopher Edmunds,Stefan Ehrentraut,Nadia El-Fellah,Muhammed Elhadi,Ahmed Elhadi,P. Escudero-Acha,Missael Espinoza,Clelia Esposito,Fabrizio Fabretti,Daniel Fein,Massimo Ferluga,Marco Fernandes,Alexis Ferré,Janet Ferrier,Marek Flaksa,Fernando Flores,Jesus Flores Gonzalez,Xavier Fonseca Fuentes,Roland C. E. Francis,Daniela G. Franco,Pawel Franczyk,Jean‐Pierre Frat,Mikhail Furman,Maurizio Fusari,Piotr Gałkin,Alice Gallo De Moraes,Renato Gammaldi,Maria F. García Aguilera,Eugenio Garofalo,Tomasz Gaszyński,Jonathan Gatward,Mohamed Ghula,Angelo Giacomucci,Ilaria Giovannini,Kingsly Robert Gnanadurai,Thomas Godet,Alberto Goffi,Gemma Goma Fernandez,María del Carmen Martín González,Daira González,A. González-Castro,Kadarapura Nanjundaiah Gopalakrishna,Eric Gottesman,Alexandre Gros,Christophe Guervilly,Christophe Guitton,Manish Gupta,Kulbhusahn Gupta,Tarikul Hamid,Olfa Hamzaoui,Katrin Hannesdottir,Shahnaz Hasan,Mozaffer Hossain,Sazzad Hossein,Sami Hraiech,Chun‐Kai Huang,Cameron Hypes,Soad Imhmed R. Alkhumsi,Motiul Islam,Muhamad A. Ismail,Višnja Ivančan,Sophie Jacquier,Bharat Jagiasi,Nikhilesh Jain,Muhamad Fadhil Hadi Jamaluddin,Miłosz Jankowski,Deepak Jeswani,Deepti Jeswani,Simant Jha,Laura Jones,Benjamin Jones,Mathieu Jozwiak,Aleksandra Jumić,Oliver Kamp,Ilias Karametos,A.E. Karelov,P. Katsoulis,David A. Kaufman,Shuchi Kaushik,Callum Kaye,Subba R. Kesavarapu,Ala Khaled,Hapiz Khalidah,Akram Khan,Sudhir Khunteta,Detlef Kindgen‐Milles,Sara Korula,Amol Kothekar,Salman S. Koul,Ditte Krog,Shih-Chi Ku,Mira Kuellmar,Lu-Cheng Kuo,Swarna Deepak Kuragayala,Aikaterini Kyparissi,Gonzalo Labarca,John G. Laffey,Jaya Lalwani,Antonio Landaverde,Jean-Baptiste Lascarrou,Andrés Laserna,Chien‐Chang Lee,Stéphane Legriel,Andrew Lehr,Tiago Leonor,Yongxing Li,A Licciardi,Edward Litton,В. В. Ломиворотов,Federico Longhini,Claudia L. Lopez Nava,Luis R. Loza Gallardo,Ramona Lungu,Annalisa Luzi,Wuhua Ma,М. А. Магомедов,Alexandros Μakris,Harish Mallapura Maheshwarappa,Tommaso Maraffi,Maria Elena Marcelli,Karim Mariano,Nathalie Marin,N.G. Мarova,Maëlle Martin,Mayra Martinez Gonzalez,Emilio Maseda,Fiore Mastroianni,Marijana Matas,Dubier Matos,Jessica Giuseppina Maugeri,Mohd Zulfakar Mazlan,Melanie Meersch,Ranjan Meher,Tasneem H. Mehesry,Maria Meirik,Armand Mekontso Dessap,Kwabena Mensah,Emmanuelle Mercier,Pavel Michálek,Abhirup Midya,Slobodan Mihaljević,Adrien Mirouse,Prasanna K. Mishra,Ravi Mistry,Mate Moguš,Norbaniza Mohd Nordin,Noryani Mohd Samat,Luca Montini,Giorgia Montrucchio,Valeria Moro,Diego Morocho Tutillo,Jarrod Mosier,Sircar Mrinal,Wojciech Mudyna,Grégoire Muller,Kartik Munta,Satheesh Munusamy,S Musso,Stefano Muttini,Ismail Nahla Irtiza,Evi Nakou,Amit Narkhede,Joseph Nates,M Nespoli,Francesca Nespoli,Artem Nikitenko,Carla Nogueira,Ross O'Grady,Yewande Odeyemi,Annika Ohlsson,Alberto Orsello,Vijayanand Palaniswamy,Daniela Maria Palma,Salvatore Palmese,Jesus N. Pantoja Leal,E. Papandreou,Metaxia Papanikolaou,Matteo Parotto,Mayur Patel,Mario Pavlek,Niccolò Pedrotti,Ngu Pei Hwa,Lorella Pelagalli,Miryam Pérez Ruiz,Elin Persson,Athanasia Petsiou,Angelo Pezzi,Sam Philip,Francois Philippard,Mariusz Piegat,Sébastien Pili‐Floury,Riccardo Pinciroli,Márcia Pinto,Gaël Piton,Gaëtan Plantefève,Caroline Pouplet,Sofia Pouriki,A Pradella,Kumar Prashant,Christian Putensen,Alice Quayle,Lua Rahmani,Ian Randall,Banambar Ray,Adrian Regli,Syed T. Reza,Jean Damien Ricard,Ivano Riva,Oriol Roca,Roberto Rona,Jon Rosell,Rebecca Rowley,Sheng‐Yuan Ruan,Kay Rumschuessel,Annalisa Rundo,Pierpaolo Russo,Vincenzo Russotto,Samir Sahu,Gabriele Sales,Charlotte Salmon-Gandonnière,Nandyelly San Juan Roman,Luis Alejandro Sánchez‐Hurtado,Benjamin J. Sandefur,Manel M. Santafé,Lida Santoro,R. Sanyal,Lakshmikanthcharan Saravanabavan,Bhagyesh Shah,Mehul Shah,Ming-Hann Shin,Mónica A. Silva,Shannon Simpson,Ayush Sinah,Atul Kumar Singh,D. K. Singh,Nitesh Singh,Lalit Singh,Lukasz Skowronski,Miguel A. Gama Sosa,Savino Spadaro,Martin Spångfors,Jesper Sperber,Rosario Spina,Anand Srivastava,Andrew Steel,Alejandro Suárez-de-la-Rica,Singh Sujeet Kumar,Omprakash Sundrani,Nilu Sunil,Bharadwaj Suparna,Manimala R. Surath,Yadullah Syed,Tamás Szakmány,Benjamin Sztrymf,Alexis Tabah,Stefano Tarantino,Maria Tileli,Hugo Arturo Tirapé Castro,Otoniel Toledo-Salinas,Jacopo Tramarin,D Tsiftsis,Iva Tucić,Jose A. Tutillo León,Lorenzo Tutino,Vijay Tyagi,Kyriaki Vagdatli,Sneha Varkey,Magdalena Vera,Magnus Von Seth,C.-G. Wahlström,Wan Mohd Nazaruddin Wan Hassan,Wan Nasrudin Wan Ismail,Kuo‐Chuan Wang,Hadrien Winiszewski,Jiayan Wu,Lun Wu,Yu‐Chang Yeh,Paul J. Young,Gianluca Zani,Jonathan Zarka,Dawn Zhao,Diane Zlotnik

出处

期刊：JAMA [American Medical Association]
日期：2021-03-23 卷期号：325 (12): 1164-1164 被引量：338

链接

jamanetwork.com handle.net unife.it europepmc.org nih.gov nih.govdoi.org

标识

DOI：10.1001/jama.2021.1727

摘要

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.

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