Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries
Authors: Vincenzo Russotto, Sheila Nainan Myatra, John G. Laffey, Elena Tassistro, Laura Antolini, Philippe Bauer, Jean Baptiste Lascarrou, Konstanty Szuldrzynski, Luigi Camporota, Paolo Pelosi, Massimiliano Sorbello, Andy Higgs, Robert Greif, Christian Putensen, Christina Agvald-Öhman, Athanasios Chalkias, Kristaps Bokums, David Brewster, Emanuela Rossi, Roberto Fumagalli, Antonio Pesenti, Giuseppe Foti, Giacomo Bellani, Hazem Abdelkarem Ahmed, Neill K.J. Adhikari, Kehari Agrawal, Nipun Agrawal , Hernan Aguirre-Bermeo, Christina Agvald-Öhman, Meraj  Ahmad     , Samareh Ajami, Shazia N. Akhtar, Adnan      Alghamdi        , Abdulmueti Alhadi, Syed M. Ali, Mohd N. Ali, Anita Alias, Ghaleb Almekhlafi    , Julio Alonso, Diana  Alvarez Montenegro    , Rubina Aman, Matthew Anstey, Irene Aragão, Eleni Arnaoutoglou, Elie Azoulay , Laura Baccari, Nishanth Baliga, Ramya  Ballekatte Manjunath   , Shrirang Bamane, Anna Bandert, Roland Bartholdy, Marta Basto, Vera Baturova, Philippe R. Bauer, Agrippino Bellissima, Vladislav Belsky, Prashant Bendre, Annalisa Benini, Sebastien Besset, Mahuya Bhattacharyya, Piotr Bielanski, Luca Bigatello, Florence Boissier, Kristaps Bokums, Elisa Boni, Iwona Bonney, David Bowen, Alexandre Boyer, Luca Brazzi, David Brewster, Lina Broman, Alexander Browne, Cedric Bruel, Yannick Brunin, Guillermo Bugedo, Italo Calamai, Patricia Campos, Federico G. Canavosio, Iacopo Cappellini, Marco Cascella, Nuno Catorze, Athanasios Chalkias, Benoit 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, Gwenhael Colin, Jean-Michel Constantin, Damien Contou       , Andrea Cortegiani, Paulo F. Costa, Vasco Costa, Andrea Costamagna, Antonella Cotoia, Andrea N. Cracchiolo, Petra Crone, Rui P. Cunha, Renata Curic Radivojevic, Amit 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 F. Ehrentraut, Nadia El-Fellah      , Muhammed Elhadi, Ahmed Elhadi, Patricia Escudero-Acha, Missael Espinoza, Clelia Esposito, Fabrizio Fabretti, Daniel G. Fein, Massimo Ferluga, Marco Fernandes, Alexis Ferre, Janet Ferrier, Marek Flaksa, Fernando Flores, Jesus Flores Gonzalez, Xavier E. Fonseca Fuentes, Roland Francis, Daniela G. Franco, Pawel Franczyk, Jean-Pierre Frat, Mikhail Furman, Maurizio Fusari, Piotr Galkin, Alice Gallo de Moraes, Renato Gammaldi, Maria F. García Aguilera, Eugenio Garofalo, Tomasz Gaszynski, Jonathan Gatward, Mohamed Ghula, Angelo Giacomucci, Ilaria Giovannini, Kingsly         Gnanadurai       , Thomas Godet, Alberto Goffi, Gemma Goma Fernandez, Maria Gonzalez, Daira González, Alejandro González-Castro, Kadarapura N. 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 Alkhumsi, Motiul Islam, Muhamad A. Ismail, Višnja Ivancan, Sophie Jacquier, Bharat Jagiasi, Nikhilesh Jain, Muhamad Fadhil Hadi Jamaluddin, Milosz Jankowski, Deepak Jeswani, Deepti Jeswani, Simant       Jha, Laura Jones, Benjamin Jones, Mathieu Jozwiak, Aleksandra Jumic, Oliver Kamp, Ilias Karametos, Alexey Karelov, Panagiotis Katsoulis, David A. Kaufman, Shuchi        Kaushik       , Callum T. Kaye, Subba R. Kesavarapu, Ala Khaled, Hapiz    Khalidah     , Akram Khan, Sudhir Khunteta, Detlef Kindgen-Milles, Sara V. Korula, Amol Kothekar, Salman S. Koul, Ditte Krog, Shih-Chi Ku, Mira Kuellmar, Lu-Cheng Kuo, Swarna D. Kuragayala, Aikaterini       Kyparissi     , Gonzalo Labarca, John G. Laffey, Jaya     Lalwani      , Antonio Landaverde, Jean-Baptiste Lascarrou, Andres Laserna, Chien-Chang Lee, Stephane Legriel      , Andrew Lehr, Tiago Leonor, Yongxing Li, Anna Lisa Licciardi, Edward Litton, Vladimir Lomivorotov, Federico Longhini, Claudia L. Lopez Nava, Luis R. Loza Gallardo, Ramona Lungu, Annalisa Luzi, Wuhua Ma, Marat Magomedov, Alexandros Makris, Harish Mallapura Maheshwarappa, Tommaso Maraffi, Maria E. Marcelli, Karim Mariano, Nathalie Marin, Nadezhda Marova, Maelle Martin, Mayra Martinez Gonzalez, Emilio Maseda, Fiore Mastroianni, Marijana Matas, Dubier Matos, Jessica G. Maugeri, Mohd Z. Mazlan, Melanie Meersch, Ranjan Meher, Tasneem H. Mehesry, Maria Meirik, Armand Mekontso Dessap, Kwabena Mensah, Emmanuelle Mercier, Pavel Michalek, Abhirup Midya, Slobodan Mihaljevic, Adrien Mirouse , Prasanna 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   , Stefania Musso, Stefano Muttini, Ismail     Nahla Irtiza      , Evi     Nakou   , Amit Narkhede, Joseph Nates, Moana R. Nespoli, Francesca Nespoli, Artem Nikitenko, Carla Nogueira, Ross O'Grady, Yewande E. Odeyemi, Annika Ohlsson, Alberto Orsello, Vijayanand Palaniswamy, Daniela M. Palma, Salvatore Palmese, Jesus N. Pantoja Leal, Eleni 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, Marcia Pinto, Gael Piton, Gaetan Plantefeve    , Caroline Pouplet, Sofia Pouriki, Andrea 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 Sánchez-Hurtado, Benjamin J. Sandefur, Manel Santafe, Lida Santoro, Rhik Sanyal, Lakshmikanthcharan Saravanabavan   , Bhagyesh       Shah      , Mehul      Shah      , Ming-Hann Shin, Monica Silva, Shannon Simpson, Ayush Sinah, Atul K. Singh, Dinesh K. Singh, Nitesh          Singh , Lalit Singh     , Lukasz Skowronski, Miguel A. Sosa, Savino Spadaro, Martin Spangfors, Jesper Sperber, Rosario Spina, Anand Srivastava, Andrew Steel, Alejandro Suarez de la Rica, Singh Sujeet Kumar, Omprakash           Sundrani, Nilu Sunil, Bharadwaj Suparna, Manimala R. Surath     , Yadullah Syed, Tamas Szakmany, Benjamin Sztrymf, Alexis Tabah, Stefano Tarantino, Maria Tileli, Hugo Tirape-Castro, Otoniel Toledo-Salinas, Jacopo Tramarin, Dimitrios Tsiftsis, Iva Tucic, Jose A. Tutillo León, Lorenzo  Tutino, Vijay N. Tyagi, Kyriaki Vagdatli, Sneha Varkey, Maria M. Vera, Magnus Von Seth, Carl Wahlstrom, Wan Mohd N. Wan Hassan, Wan N. Wan Ismail      , Kuo-Chuan Wang, Hadrien Winiszewski, Jiayan Wu, Lun Wu, Yu-Chang Yeh, Paul Young, Gianluca Zani, Jonathan Zarka, Dawn Zhao, Diane Zlotnik
Journal: JAMA (2021)

<h3>Importance</h3> 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. <h3>Objective</h3> To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Tracheal intubation. <h3>Main Outcomes and Measures</h3> 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 &lt;65 mm Hg at least once, &lt;90 mm Hg for &gt;30 minutes, new or increase need of vasopressors or fluid bolus &gt;15 mL/kg), severe hypoxemia (peripheral oxygen saturation &lt;80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality. <h3>Results</h3> 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%. <h3>Conclusions and Relevance</h3> 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.