Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill: Insights from the INTUBE Study

• DOI: 10.1164/rccm.202111-2575oc
• Publication Date: 2022-05-10T15:02:46Z
• Authors: Vincenzo Russotto; Elena Tassistro; Sheila N. Myatra; Matteo Parotto; Laura Antolini; Philippe Bauer; Jean Baptiste Las...; Konstanty Szułdrz...; Luigi Camporota; Christian Putensen; Paolo Pelosi; Massimiliano Sorb...; Andy Higgs; Robert Greif; Antonio Pesenti; Maria Grazia Vals...; Roberto Fumagalli; Giuseppe Foti; Giacomo Bellani; John G. Laffey
• Keywords: Pulse Oximetry; Pulse pressure

Rationale: Cardiovascular instability/collapse is a common peri-intubation event in patients who are critically ill. Objectives: To identify potentially modifiable variables associated with cardiovascular (i.e., systolic arterial pressure <65 mm Hg [once] or <90 for >30 minutes; new/increased vasopressor requirement; fluid bolus >15 ml/kg, cardiac arrest). Methods: INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was multicenter prospective cohort study were ill undergoing tracheal intubation convenience sample 197 sites from 29 countries across five continents October 1, 2018, July 31, 2019. Measurements Main Results: A total 2,760 included this analysis. Peri-intubation occurred 1,199 out (43.4%). Variables older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.03), higher heart rate (OR, 1.008; CI, 1.004-1.012), lower blood 0.98; 0.98-0.99), oxygen saturation as measured by pulse oximetry/FiO2 before induction 0.998; 0.997-0.999), use propofol an agent 1.28; 1.05-1.57). Patients at risk ICU mortality adjusted OR 2.47 (95% 1.72-3.55), P < 0.001. The inverse probability treatment weighting method identified only factor independently 1.23; 1.02-1.49). When administered induction, vasopressors 1.33; 0.84-2.11) boluses 1.17; 0.96-1.44) did not reduce incidence instability/collapse. Conclusions: increased both 28-day mortality. intervention significantly instability/collapse.Clinical trial registered clinicaltrials.gov (NCT03616054).