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

Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, Constantin JM - Crit Care (2015)

Bottom Line: This study assessed the incidence of severe CVC after ETI in the ICU and analyzed the factors predictive of severe CVC.Severe CVC occurred following 264 of 885 (29.8 %) intubation procedures.CVC is a frequent complication, especially in old and severely ill patients intubated for acute respiratory failure in the ICU.

View Article: PubMed Central - PubMed

Affiliation: Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. sperbet@chu-clermontferrand.fr.

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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Related in: MedlinePlus

Study flow chart
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Fig1: Study flow chart

Mentions: During the study period, 1,400 intubation procedures were performed in 1,360 patients. After excluding 41 patients who underwent intubation for cardiac arrest, 212 who underwent intubation for shock and 262 who received vasoactive drugs before intubation, 885 intubation procedures were included (Fig. 1).Fig. 1


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

Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, Constantin JM - Crit Care (2015)

Study flow chart
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4495680&req=5

Fig1: Study flow chart
Mentions: During the study period, 1,400 intubation procedures were performed in 1,360 patients. After excluding 41 patients who underwent intubation for cardiac arrest, 212 who underwent intubation for shock and 262 who received vasoactive drugs before intubation, 885 intubation procedures were included (Fig. 1).Fig. 1

Bottom Line: This study assessed the incidence of severe CVC after ETI in the ICU and analyzed the factors predictive of severe CVC.Severe CVC occurred following 264 of 885 (29.8 %) intubation procedures.CVC is a frequent complication, especially in old and severely ill patients intubated for acute respiratory failure in the ICU.

View Article: PubMed Central - PubMed

Affiliation: Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. sperbet@chu-clermontferrand.fr.

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.

Show MeSH
Related in: MedlinePlus