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. 2024 May 1;52(5):786-797.
doi: 10.1097/CCM.0000000000006198. Epub 2024 Jan 23.

A Nationwide, Prospective Study of Tracheal Intubation in Critically Ill Adults in Spain: Management, Associated Complications, and Outcomes

José Garnacho-Montero  1 , Elena Gordillo-Escobar  1 , Josep Trenado  2 , Federico Gordo  3 , Lourdes Fisac  4 , Emilio García-Prieto  5 , Cristina López-Martin  6 , Ana Abella  3 , Juan Ramón Jiménez  1 , José Luis García-Garmendia  7 ; and the Intubation Prospective (INTUPROS) Study Investigators
Affiliations

A Nationwide, Prospective Study of Tracheal Intubation in Critically Ill Adults in Spain: Management, Associated Complications, and Outcomes

José Garnacho-Montero et al. Crit Care Med. .

Abstract

Objectives: Our aims were to explore current intubation practices in Spanish ICUs to determine the incidence and risk factors of peri-intubation complications (primary outcome measure: major adverse events), the rate and factors associated with first-pass success, and their impact on mortality as well as the changes of the intubation procedure observed in the COVID-19 pandemic.

Design: Prospective, observational, and cohort study.

Setting: Forty-three Spanish ICU.

Patients: A total of 1837 critically ill adult patients undergoing tracheal intubation. The enrollment period was six months (selected by each center from April 16, 2019, to October 31, 2020).

Interventions: None.

Measurement and main results: At least one major adverse peri-intubation event occurred in 40.4 % of the patients (973 major adverse events were registered) the most frequent being hemodynamic instability (26.5%) and severe hypoxemia (20.3%). The multivariate analysis identified seven variables independently associated with a major adverse event whereas the use of neuromuscular blocking agents (NMBAs) was associated with reduced odds of major adverse events. Intubation on the first attempt was achieved in 70.8% of the patients. The use of videolaryngoscopy at the first attempt was the only protective factor (odds ratio 0.43; 95% CI, 0.28-0.66; p < 0.001) for first-attempt intubation failure. During the COVID-19 pandemic, the use of videolaryngoscopy and NMBAs increased significantly. The occurrence of a major peri-intubation event was an independent risk factor for 28-day mortality. Cardiovascular collapse also posed a serious threat, constituting an independent predictor of death.

Conclusions: A major adverse event occurred in up to 40% of the adults intubated in the ICU. Peri-intubation hemodynamic instability but not severe hypoxemia was identified as an independent predictor of death. The use of NMBAs was a protective factor for major adverse events, whereas the use of videolaringoscopy increases the first-pass success rate of intubation. Intubation practices changed during the COVID-19 pandemic.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Comment in

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