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Observational Study
. 2015 Jun 18;19(1):257.
doi: 10.1186/s13054-015-0975-9.

Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study

Sebastien Perbet  1 , Audrey De Jong  2 , Julie Delmas  3 , Emmanuel Futier  4 , Bruno Pereira  5 , Samir Jaber  6 , Jean-Michel Constantin  7
Affiliations
Observational Study

Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study

Sebastien Perbet et al. Crit Care. .

Abstract

Introduction: Severe cardiovascular collapse (CVC) is a life-threatening complication after emergency endotracheal intubation (ETI) in the ICU. Many factors may interact with hemodynamic conditions during ETI, but no study to date has focused on factors associated with severe CVC occurrence. This study assessed the incidence of severe CVC after ETI in the ICU and analyzed the factors predictive of severe CVC.

Methods: This was a secondary analysis of a prospective multicenter study of 1,400 consecutive intubations at 42 ICUs. The incidence of severe CVC was assessed in patients who were hemodynamically stable (mean arterial blood pressure >65 mmHg without vasoactive drugs) before intubation, and the factors predictive of severe CVC were determined by multivariate analysis based on patient and procedure characteristics.

Results: Severe CVC occurred following 264 of 885 (29.8 %) intubation procedures. A two-step multivariate analysis showed that independent risk factors for CVC included simple acute physiologic score II regardless of age (odds ratio (OR) 1.02, p < 0.001), age 60-75 years (OR 1.96, p < 0.002 versus <60 years) and >75 years (OR 2.81, p < 0.001 versus <60 years), acute respiratory failure as a reason for intubation (OR 1.51, p = 0.04), first intubation in the ICU (OR 1.61, p = 0.02), noninvasive ventilation as a preoxygenation method (OR 1.54, p = 0.03) and inspired oxygen concentration >70 % after intubation (OR 1.91, p = 0.001). Comatose patients who required ETI were less likely to develop CVC during intubation (OR 0.48, p = 0.004).

Conclusions: CVC is a frequent complication, especially in old and severely ill patients intubated for acute respiratory failure in the ICU. Specific bundles to prevent CVC may reduce morbidity and mortality related to intubation of these high-risk, critically ill patients.

Trial registration: clinicaltrials.gov NCT01532063 ; registered 8 February 2012.

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Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Forrest plot. FiO2 inspired oxygen concentration, NIV noninvasive ventilation, SAPS Simplified Acute Physiologic Score
See this image and copyright information in PMC

References

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