Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill: Insights from the INTUBE Study.
In: American Journal of Respiratory & Critical Care Medicine, Jg. 206 (2022-08-15), Heft 4, S. 449-480
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Zugriff:
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 <90 mm Hg for >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.Clinical trial registered with clinicaltrials.gov (NCT03616054). [ABSTRACT FROM AUTHOR]
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Titel: |
Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill: Insights from the INTUBE Study.
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Autor/in / Beteiligte Person: | Russotto, Vincenzo ; Tassistro, Elena ; Myatra, Sheila N. ; Parotto, Matteo ; Antolini, Laura ; Bauer, Philippe ; Lascarrou, Jean Baptiste ; Szułdrzyński, Konstanty ; Camporota, Luigi ; Putensen, Christian ; Pelosi, Paolo ; Sorbello, Massimiliano ; Higgs, Andy ; Greif, Robert ; Pesenti, Antonio ; Valsecchi, Maria Grazia ; Fumagalli, Roberto ; Foti, Giuseppe ; Bellani, Giacomo ; Laffey, John G. |
Zeitschrift: | American Journal of Respiratory & Critical Care Medicine, Jg. 206 (2022-08-15), Heft 4, S. 449-480 |
Veröffentlichung: | 2022 |
Medientyp: | academicJournal |
ISSN: | 1073-449X (print) |
DOI: | 10.1164/rccm.202111-2575OC |
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