Department of Anesthesia and Critical Care, University Hospital San Luigi Gonzaga, University of Turin, Italy.
Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center) and.
Am J Respir Crit Care Med. 2022 Aug 15;206(4):449-458. doi: 10.1164/rccm.202111-2575OC.
Cardiovascular instability/collapse is a common peri-intubation event in patients who are critically ill. To identify potentially modifiable variables associated with peri-intubation cardiovascular instability/collapse (i.e., systolic arterial pressure <65 mm Hg [once] or <90 mm Hg for >30 minutes; new/increased vasopressor requirement; fluid bolus >15 ml/kg, or cardiac arrest). INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was a multicenter prospective cohort study of patients who were critically ill and undergoing tracheal intubation in a convenience sample of 197 sites from 29 countries across five continents from October 1, 2018, to July 31, 2019. A total of 2,760 patients were included in this analysis. Peri-intubation cardiovascular instability/collapse occurred in 1,199 out of 2,760 patients (43.4%). Variables associated with this event were older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.02-1.03), higher heart rate (OR, 1.008; 95% CI, 1.004-1.012), lower systolic blood pressure (OR, 0.98; 95% CI, 0.98-0.99), lower oxygen saturation as measured by pulse oximetry/Fi before induction (OR, 0.998; 95% CI, 0.997-0.999), and the use of propofol as an induction agent (OR, 1.28; 95% CI, 1.05-1.57). Patients with peri-intubation cardiovascular instability/collapse were at a higher risk of ICU mortality with an adjusted OR of 2.47 (95% CI, 1.72-3.55), < 0.001. The inverse probability of treatment weighting method identified the use of propofol as the only factor independently associated with cardiovascular instability/collapse (OR, 1.23; 95% CI, 1.02-1.49). When administered before induction, vasopressors (OR, 1.33; 95% CI, 0.84-2.11) or fluid boluses (OR, 1.17; 95% CI, 0.96-1.44) did not reduce the incidence of cardiovascular instability/collapse. Peri-intubation cardiovascular instability/collapse was associated with an increased risk of both ICU and 28-day mortality. The use of propofol for induction was identified as a modifiable intervention significantly associated with cardiovascular instability/collapse.Clinical trial registered with clinicaltrials.gov (NCT03616054).
心血管不稳定/衰竭是危重病患者气管插管时常见的围插管期事件。为了确定与围插管期心血管不稳定/衰竭（即收缩压<65mmHg[一次]或<90mmHg 持续>30 分钟；新/增加血管加压药需求；液体负荷量>15ml/kg 或心搏骤停）相关的潜在可改变变量。INTUBE（国际观察性研究，旨在了解危重患者气道管理的影响和最佳实践）是一项多中心前瞻性队列研究，纳入了在 2018 年 10 月 1 日至 2019 年 7 月 31 日期间，来自五大洲 29 个国家的 197 个便利样本点中，危重病患者在进行气管插管时的情况。共纳入 2760 例患者。2760 例患者中有 1199 例（43.4%）发生围插管期心血管不稳定/衰竭。与该事件相关的变量为年龄较大（比值比[OR]，1.02；95%置信区间[CI]，1.02-1.03）、心率较高（OR，1.008；95%CI，1.004-1.012）、收缩压低（OR，0.98；95%CI，0.98-0.99）、诱导前脉搏血氧饱和度/Fi 测量值低（OR，0.998；95%CI，0.997-0.999）和使用异丙酚作为诱导剂（OR，1.28；95%CI，1.05-1.57）。发生围插管期心血管不稳定/衰竭的患者 ICU 死亡率较高，校正比值比（OR）为 2.47（95%CI，1.72-3.55），<0.001。逆概率治疗加权法确定使用异丙酚是唯一与心血管不稳定/衰竭相关的独立因素（OR，1.23；95%CI，1.02-1.49）。当在诱导前使用时，血管加压药（OR，1.33；95%CI，0.84-2.11）或液体负荷（OR，1.17；95%CI，0.96-1.44）并不能降低心血管不稳定/衰竭的发生率。围插管期心血管不稳定/衰竭与 ICU 和 28 天死亡率增加相关。异丙酚诱导被确定为与心血管不稳定/衰竭显著相关的可改变干预措施。临床试验在 clinicaltrials.gov 注册（NCT03616054）。
