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

• DOI: 10.1001/jama.2021.1727
• Publication Date: 2021-03-23T11:20:30Z
• Authors: Vincenzo Russotto; Sheila Nainan Myatra; John G. Laffey; Elena Tassistro; Laura Antolini; Philippe Bauer; Jean Baptiste Las...; Konstanty Szuldrz...; Luigi Camporota; Paolo Pelosi; Massimiliano Sorb...; Andy Higgs; Robert Greif; Christian Putensen; Christina Agvald-...; Athanasios Chalkias; Kristaps Bokums; David Brewster; Emanuela Rossi; Roberto Fumagalli; Antonio Pesenti; Giuseppe Foti; Giacomo Bellani; ; Hazem Abdelkarem ...; Neill K.J. Adhikari; Kehari Agrawal; Nipun Agrawal; Hernan Aguirre-Be...; Christina Agvald-...; Meraj Ahmad; Samareh Ajami; Shazia N. Akhtar; Adnan Algham...; Abdulmueti Alhadi; Syed M. Ali; Mohd N. Ali; Anita Alias; Ghaleb Almekhlafi...; Julio Alonso; Diana Alvarez Mo...; Rubina Aman; Matthew Anstey; Irene Aragão; Eleni Arnaoutoglou; Elie Azoulay; Laura Baccari; Nishanth Baliga; Ramya Ballekatte...; 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. Canav...; 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 Const...; Damien Contou; Andrea Cortegiani; Paulo F. Costa; Vasco Costa; Andrea Costamagna; Antonella Cotoia; Andrea N. Cracchiolo; Petra Crone; Rui P. Cunha; Renata Curic Radi...; Amit Das; Sampat Dash; Gennaro De Pascale; Silvia De Rosa; Lorenzo Del Sorbo; Valentina Della T...; Barbara Di Caprio; Raffaele Di Fenza; Ida Di Giacinto; Aikaterini ...; Marcel Dudda; Christopher Edmunds; Stefan F. Ehrentraut; Nadia El-Fellah ...; Muhammed Elhadi; Ahmed Elhadi; Patricia Escudero...; Missael Espinoza; Clelia Esposito; Fabrizio Fabretti; Daniel G. Fein; Massimo Ferluga; Marco Fernandes; Alexis Ferre; Janet Ferrier; Marek Flaksa; Fernando Flores; Jesus Flores Gonz...; Xavier E. Fonseca...; Roland Francis; Daniela G. Franco; Pawel Franczyk; Jean-Pierre Frat; Mikhail Furman; Maurizio Fusari; Piotr Galkin; Alice Gallo de Mo...; Renato Gammaldi; Maria F. García A...; Eugenio Garofalo; Tomasz Gaszynski; Jonathan Gatward; Mohamed Ghula; Angelo Giacomucci; Ilaria Giovannini; Kingsly G...; Thomas Godet; Alberto Goffi; Gemma Goma Fernandez; Maria Gonzalez; Daira González; Alejandro Gonzále...; Kadarapura N. Gop...; 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 Ha...; 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 Kau...; Callum T. Kaye; Subba R. Kesavarapu; Ala Khaled; Hapiz Khalidah...; Akram Khan; Sudhir Khunteta; Detlef Kindgen-Mi...; Sara V. Korula; Amol Kothekar; Salman S. Koul; Ditte Krog; Shih-Chi Ku; Mira Kuellmar; Lu-Cheng Kuo; Swarna D. Kuragayala; Aikaterini ...; Gonzalo Labarca; John G. Laffey; Jaya Lalwani ...; Antonio Landaverde; Jean-Baptiste Las...; 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 ...; Luis R. Loza Gall...; Ramona Lungu; Annalisa Luzi; Wuhua Ma; Marat Magomedov; Alexandros Makris; Harish Mallapura ...; Tommaso Maraffi; Maria E. Marcelli; Karim Mariano; Nathalie Marin; Nadezhda Marova; Maelle Martin; Mayra Martinez Go...; 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 D...; Kwabena Mensah; Emmanuelle Mercier; Pavel Michalek; Abhirup Midya; Slobodan Mihaljevic; Adrien Mirouse; Prasanna Mishra; Ravi Mistry; Mate Moguš; Norbaniza Mohd No...; Noryani Mohd Samat; Luca Montini; Giorgia Montrucchio; Valeria Moro; Diego Morocho Tut...; Jarrod Mosier; Sircar Mrinal; Wojciech Mudyna; Grégoire Muller; Kartik Mun...; Satheesh Munusamy; Stefania Musso; Stefano Muttini; Ismail Nahla ...; 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 Palani...; Daniela M. Palma; Salvatore Palmese; Jesus N. Pantoja ...; Eleni Papandreou ...; Metaxia Papanikolaou; Matteo Parotto; Mayur Patel; Mario Pavlek; Niccolò Pedrotti; Ngu Pei Hwa; Lorella Pelagalli; Miryam Pérez Ruiz; Elin Persson; Athanasia ...; Angelo Pezzi; Sam Philip; Francois Philippa...; Mariusz Piegat; Sébastien Pili-Fl...; 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-...; Nandyelly San ...; Luis Sánchez-Hurtado; Benjamin J. Sandefur; Manel Santafe; Lida Santoro; Rhik Sanyal; Lakshmikanthchara...; Bhagyesh Sh...; Mehul Shah ...; Ming-Hann Shin; Monica Silva; Shannon Simpson; Ayush Sinah; Atul K. Singh; Dinesh K. Singh; Nitesh S...; Lalit Singh; Lukasz Skowronski; Miguel A. Sosa; Savino Spadaro; Martin Spangfors; Jesper Sperber; Rosario Spina; Anand Srivastava; Andrew Steel; Alejandro Suarez ...; Singh Sujeet Kumar; Omprakash ...; Nilu Sunil; Bharadwaj Suparna; Manimala R. Surat...; Yadullah Syed; Tamas Szakmany; Benjamin Sztrymf; Alexis Tabah; Stefano Tarantino; Maria Tileli; Hugo Tirape-Castro; Otoniel Toledo-Sa...; 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 H...; 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
• Keywords: Interquartile range

<h3>Importance</h3> Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information available on adverse peri-intubation events. <h3>Objective</h3> To evaluate incidence nature events to assess current practice <h3>Design, Setting, Participants</h3> The International Observational Study Understand Impact Best Practices Airway Management Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort involving consecutive patients undergoing tracheal intensive care units (ICUs), emergency departments, wards, from October 1, 2018, July 31, 2019 (August 28, 2019, final follow-up) a convenience sample 197 sites 29 countries across 5 continents. <h3>Exposures</h3> intubation. <h3>Main Outcomes Measures</h3> primary outcome major defined as at least 1 following occurring within 30 minutes start procedure: cardiovascular instability (either: systolic pressure &lt;65 mm Hg once, &lt;90 for &gt;30 minutes, new or increase need vasopressors fluid bolus &gt;15 mL/kg), severe hypoxemia (peripheral oxygen saturation &lt;80%) cardiac arrest. secondary outcomes included unit mortality. <h3>Results</h3> Of 3659 screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 62.6% men) continents were included. main reason respiratory failure 52.3% patients, followed by neurological impairment 30.5%, 9.4%. Primary data all Among 45.2% experienced event. predominant event instability, observed 42.6% intubation, (9.3%) arrest (3.1%). Overall ICU mortality 32.8%. <h3>Conclusions Relevance</h3> In this observational practices countries, events—in particular instability—were frequently.