Original Investigation Caring for the Critically Ill PatientMarch 23/30, 2021

Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries

Vincenzo Russotto, Sheila Nainan Myatra, John G. Laffey, et al

JAMA. 2021;325(12):1164-1172. doi:10.1001/jama.2021.1727

Abstract

Importance 背景

Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events.

对于危重病患者而言，气管插管是最常使用也是最高危的操作之一。有关插管前后不良事件仅有很有限的资料。

Objective 目的

To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients.

评价气管插管前后不良事件的发生率及性质，评估危重病患者气管插管的现状。

Design, Setting, and Participants 设计，场景及研究对象

The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents.

了解危重病患者气道管理影响及最佳实践的国际观察性研究(INTUBE)是一项国际多中心、前瞻队列研究，2018年10月1日至2019年7月31日间，在5个洲29个国家的197个中心，纳入在ICU、急诊科和病房连续接受气管插管的危重病患者。

Exposures 暴露因素

Tracheal intubation.

气管插管

Main Outcomes and Measures 主要结局指标

The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure <65 mm Hg at least once, <90 mm Hg for >30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation <80%) or cardiac arrest. The secondary outcomes included intensive care unit mortality.

主要结局指标为气管插管前后严重不良事件发生率，定义为气管插管操作开始后30分钟内发生的至少一种以下事件：心血管不稳定（收缩压<65 mm Hg至少一次，或<90 mm Hg 持续 >30 分钟，或需要升压药物或升压药物需求增加，或快速补液>15 mL/kg），严重低氧血症（SpO2 <80）或心跳骤停。次要结局指标包括ICU病死率。

Results 结果

Of 3659 patients screened, 2964 (median age, 63 years; interquartile range [IQR], 49-74 years; 62.6% men) from 197 sites across 5 continents were included. The main reason for intubation was respiratory failure in 52.3% of patients, followed by neurological impairment in 30.5%, and cardiovascular instability in 9.4%. Primary outcome data were available for all patients. Among the study patients, 45.2% experienced at least 1 major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 42.6% of all patients undergoing emergency intubation, followed by severe hypoxemia (9.3%) and cardiac arrest (3.1%). Overall ICU mortality was 32.8%.

5个州197个中心共筛查3659名患者，最终2964名 (中位年龄, 63 岁; 四分位区间 [IQR], 49-74 岁; 62.6% 男性) 纳入分析。气管插管的主要原因为呼吸功能衰竭(52.3%)，其次分别为神经系统功能障碍(30.5%) 及心血管不稳定(9.4%)。所有患者都有主要结局指标。在所有患者中，45.2%经历至少一种插管前后严重不良事件。最常见的事件为心血管不稳定，接受紧急插管的患者中42.6%发生，其次分别为严重低氧血症 (9.3%) 和心跳骤停 (3.1%)。ICU病死率32.8%。

Conclusions and Relevance 结论与意义

In this observational study of intubation practices in critically ill patients from a convenience sample of 197 sites across 29 countries, major adverse peri-intubation events—in particular cardiovascular instability—were observed frequently.

在这项29个国家197个中心的危重病患者气管插管临床实践的观察性研究中，气管插管前后经常观察到严重不良事件，尤其是心血管不稳定。