Rationale: Cardiovascular instability/collapse is a common peri-intubation event in patients who are critically ill. Objectives: To identify potentially modifiable variables associated with peri-intubation cardiovascular instability/collapse (i.e., systolic arterial pressure <65 mm Hg [once] or [removed]30 minutes; new/increased vasopressor requirement; fluid bolus >15 ml/kg, or cardiac arrest). Methods: INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was a multicenter prospective cohort study of patients who were critically ill and undergoing tracheal intubation in a convenience sample of 197 sites from 29 countries across five continents from October 1, 2018, to July 31, 2019. Measurements and Main Results: A total of 2,760 patients were included in this analysis. Peri-intubation cardiovascular instability/ collapse occurred in 1,199 out of 2,760 patients (43.4%). Variables associated with this event were older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.03), higher heart rate (OR, 1.008; 95% CI, 1.004-1.012), lower systolic blood pressure (OR, 0.98; 95% CI, 0.98-0.99), lower oxygen saturation as measured by pulse oximetry/ FIO2 before induction (OR, 0.998; 95% CI, 0.997-0.999), and the use of propofol as an induction agent (OR, 1.28; 95% CI, 1.05-1.57). Patients with peri-intubation cardiovascular instability/collapse were at a higher risk of ICU mortality with an adjusted OR of 2.47 (95% CI, 1.72-3.55), P < 0.001. The inverse probability of treatment weighting method identified the use of propofol as the only factor independently associated with cardiovascular instability/collapse (OR, 1.23; 95% CI, 1.02-1.49). When administered before induction, vasopressors (OR, 1.33; 95% CI, 0.84-2.11) or fluid boluses (OR, 1.17; 95% CI, 0.96-1.44) did not reduce the incidence of cardiovascular instability/collapse. Conclusions: Peri-intubation cardiovascular instability/collapse was associated with an increased risk of both ICU and 28-day mortality. The use of propofol for induction was identified as a modifiable intervention significantly associated with cardiovascular instability/collapse.

Russotto, V., Tassistro, E., Myatra, S., Parotto, M., Antolini, L., Bauer, P., et al. (2022). Peri-intubation Cardiovascular Collapse in Critically Ill Patients: Insights from the INTUBE Study. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 206(4 (Aug 15, 2022)), 449-458 [10.1164/rccm.202111-2575OC].

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

Tassistro, Elena
Secondo
;
Antolini, Laura;Valsecchi, Maria Grazia;Fumagalli, Roberto;Foti, Giuseppe;Bellani, Giacomo
Penultimo
;
2022

Abstract

Rationale: Cardiovascular instability/collapse is a common peri-intubation event in patients who are critically ill. Objectives: To identify potentially modifiable variables associated with peri-intubation cardiovascular instability/collapse (i.e., systolic arterial pressure <65 mm Hg [once] or [removed]30 minutes; new/increased vasopressor requirement; fluid bolus >15 ml/kg, or cardiac arrest). Methods: INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was a multicenter prospective cohort study of patients who were critically ill and undergoing tracheal intubation in a convenience sample of 197 sites from 29 countries across five continents from October 1, 2018, to July 31, 2019. Measurements and Main Results: A total of 2,760 patients were included in this analysis. Peri-intubation cardiovascular instability/ collapse occurred in 1,199 out of 2,760 patients (43.4%). Variables associated with this event were older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.03), higher heart rate (OR, 1.008; 95% CI, 1.004-1.012), lower systolic blood pressure (OR, 0.98; 95% CI, 0.98-0.99), lower oxygen saturation as measured by pulse oximetry/ FIO2 before induction (OR, 0.998; 95% CI, 0.997-0.999), and the use of propofol as an induction agent (OR, 1.28; 95% CI, 1.05-1.57). Patients with peri-intubation cardiovascular instability/collapse were at a higher risk of ICU mortality with an adjusted OR of 2.47 (95% CI, 1.72-3.55), P < 0.001. The inverse probability of treatment weighting method identified the use of propofol as the only factor independently associated with cardiovascular instability/collapse (OR, 1.23; 95% CI, 1.02-1.49). When administered before induction, vasopressors (OR, 1.33; 95% CI, 0.84-2.11) or fluid boluses (OR, 1.17; 95% CI, 0.96-1.44) did not reduce the incidence of cardiovascular instability/collapse. Conclusions: Peri-intubation cardiovascular instability/collapse was associated with an increased risk of both ICU and 28-day mortality. The use of propofol for induction was identified as a modifiable intervention significantly associated with cardiovascular instability/collapse.
Articolo in rivista - Articolo scientifico
airway management; cardiovascular collapse; Intubation;
English
449
458
10
Russotto, V., Tassistro, E., Myatra, S., Parotto, M., Antolini, L., Bauer, P., et al. (2022). Peri-intubation Cardiovascular Collapse in Critically Ill Patients: Insights from the INTUBE Study. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 206(4 (Aug 15, 2022)), 449-458 [10.1164/rccm.202111-2575OC].
Russotto, V; Tassistro, E; Myatra, S; Parotto, M; Antolini, L; Bauer, P; Lascarrou, J; Szułdrzyński, K; Camporota, L; Putensen, C; Pelosi, P; Sorbello, M; Higgs, A; Greif, R; Pesenti, A; Valsecchi, M; Fumagalli, R; Foti, G; Bellani, G; Laffey, J
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/374389
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