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. 2020 May 24;10(1):62.
doi: 10.1186/s13613-020-00668-6.

Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study

C Darreau  1 , F Martino  2 , M Saint-Martin  1 , S Jacquier  3 , J F Hamel  4 , M A Nay  5 , N Terzi  6 , G Ledoux  7 , F Roche-Campo  8 , L Camous  9 , F Pene  10 , T Balzer  11 , F Bagate  12 , J Lorber  13 , P Bouju  14 , C Marois  15 , R Robert  16 , S Gaudry  17 , M Commereuc  18 , M Debarre  19 , N Chudeau  1 , P Labroca  20 , K Merouani  21 , P Y Egreteau  22 , V Peigne  23 , C Bornstain  24 , E Lebas  25 , F Benezit  26 , S Vally  27 , S Lasocki  28 , A Robert  29 , A Delbove  30 , N Lerolle  31
Affiliations

Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study

C Darreau et al. Ann Intensive Care. .

Abstract

Background: No recommendation exists about the timing and setting for tracheal intubation and mechanical ventilation in septic shock.

Patients and methods: This prospective multicenter observational study was conducted in 30 ICUs in France and Spain. All consecutive patients presenting with septic shock were eligible. The use of tracheal intubation was described across the participating ICUs. A multivariate analysis was performed to identify parameters associated with early intubation (before H8 following vasopressor onset).

Results: Eight hundred and fifty-nine patients were enrolled. Two hundred and nine patients were intubated early (24%, range 4.5-47%), across the 18 centers with at least 20 patients included. The cumulative intubation rate during the ICU stay was 324/859 (38%, range 14-65%). In the multivariate analysis, seven parameters were significantly associated with early intubation and ranked as follows by decreasing weight: Glasgow score, center effect, use of accessory respiratory muscles, lactate level, vasopressor dose, pH and inability to clear tracheal secretions. Global R-square of the model was only 60% indicating that 40% of the variability of the intubation process was related to other parameters than those entered in this analysis.

Conclusion: Neurological, respiratory and hemodynamic parameters only partially explained the use of tracheal intubation in septic shock patients. Center effect was important. Finally, a vast part of the variability of intubation remained unexplained by patient characteristics. Trial registration Clinical trials NCT02780466, registered on May 23, 2016. https://clinicaltrials.gov/ct2/show/NCT02780466?term=intubatic&draw=2&rank=1.

Keywords: Mechanical ventilation; Septic shock; Tracheal intubation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Hazard of being intubated from H0 to H72
Fig. 2
Fig. 2
Percentage of patients intubated at H8 and H72 in the 18 centers with at last 20 patients included
Fig. 3
Fig. 3
Intubation frequency at H8 and H72 in patients with and without neurological or respiratory standard criteria for theoretical immediate intubation by H8
Fig. 4
Fig. 4
28-day survival according to intubation status. P = 0.87 for comparison between patients intubated early vs. delayed, and P = 0.001 for comparisons between patients intubated early vs. never intubated
See this image and copyright information in PMC

References

    1. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32:858–873. doi: 10.1097/01.CCM.0000117317.18092.E4. - DOI - PubMed
    1. Ebihara S, Hussain SNA, Danialou G, Cho W-K, Gottfried SB, Petrof BJ. Mechanical ventilation protects against diaphragm injury in sepsis: interaction of oxidative and mechanical stresses. Am J Respir Crit Care Med. 2002;165:221–228. doi: 10.1164/ajrccm.165.2.2108041. - DOI - PubMed
    1. Hussain SN, Roussos C. Distribution of respiratory muscle and organ blood flow during endotoxic shock in dogs. J Appl Physiol. 1985;1985(59):1802–1808. doi: 10.1152/jappl.1985.59.6.1802. - DOI - PubMed
    1. Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195:438–442. doi: 10.1164/rccm.201605-1081CP. - DOI - PubMed
    1. Lanone S, Taillé C, Boczkowski J, Aubier M. Diaphragmatic fatigue during sepsis and septic shock. Intensive Care Med. 2005;31:1611–1617. doi: 10.1007/s00134-005-2748-4. - DOI - PubMed

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