Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

Smischney, Nathan J.; Seisa, Mohamed O.; Heise, Katherine; Wiegand, Robert A.; Busack, Kyle D.; Loftsgard, Theodore O.; Schroeder, Darrell R.; Diedrich, Daniel A.

doi:10.21037/jtd.2017.08.138

Cited by 12 publications

(10 citation statements)

References 30 publications

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“…For example, a single-center retrospective study looking at risk factors for peri-intubation hypoxemia extended this time period to 30 minutes post-intubation. 12 Based on the aforementioned study, we feel that our study adds value to the literature by extending the time frame for peri-intubation hypoxemia and capturing data in real-time within a multi-center cohort.…”

Section: Discussionmentioning

confidence: 85%

“…Although our incidence (10.1%-11.9%) was lower than reported (18%-26%), in those who experienced our hypoxemia outcome, the risk for mortality was significantly increased after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline oxygenation. 12-13…”

Section: Discussionmentioning

confidence: 99%

“…Candidate predictor variables were chosen based on a review of prior literature [Supplement B]. 1,2,10 –13,18 These candidate variables included age, body mass index, history of congestive heart failure, history of chronic obstructive pulmonary disease, Acute Physiologic And Chronic Health Evaluation (APACHE) II score 24 hours prior to endotracheal intubation, airway related reason for endotracheal intubation (i.e., acute respiratory failure), cardiac related reason for endotracheal intubation, use of noninvasive ventilation prior to endotracheal intubation, emergency endotracheal intubation, direct laryngoscopy attempted, baseline S p O 2 , use of neuromuscular block, difficult mask ventilation, and total crystalloid 24 hours prior to endotracheal intubation. Analyses were performed using multiple logistic regression.…”

Section: Methodsmentioning

confidence: 99%

“…2,10,11 Up to a fifth of patients have peri-intubation hypoxemia, and those that do have increased ICU and hospital mortality. 12,13 Despite this, “ prospectively ” derived risk factors for peri-intubation hypoxemia in ICU patients from a multi-center cohort remain unknown.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

Smischney

Khanna

Brauer

et al. 2020

J Intensive Care Med

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Background: Little is known about hypoxemia surrounding endotracheal intubation in the critically ill. Thus, we sought to identify risk factors associated with peri-intubation hypoxemia and its effects’ on the critically ill. Methods: Data from a multicenter, prospective, cohort study enrolling 1,033 critically ill adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 were used to identify risk factors associated with peri-intubation hypoxemia and its effects on patient outcomes. We defined hypoxemia as any pulse oximetry ≤ 88% during and up to 30 minutes following endotracheal intubation. Results: In the full analysis (n = 1,033), 123 (11.9%) patients experienced the primary outcome. Five risk factors independently associated with our outcome were identified on multiple logistic regression: cardiac related reason for endotracheal intubation (OR 1.67, [95% CI 1.04, 2.69]); pre-intubation noninvasive ventilation (OR 1.66, [95% CI 1.09, 2.54]); emergency intubation (OR 1.65, [95% CI 1.06, 2.55]); moderate-severe difficult bag-mask ventilation (OR 2.68, [95% CI 1.72, 4.19]); and crystalloid administration within the preceding 24 hours (OR 1.24, [95% CI 1.07, 1.45]; per liter up to 4 liters). Higher baseline SpO2 was found to be protective (OR 0.93, [95% CI 0.91, 0.96]; per percent up to 97%). Consistent results were seen in a separate analysis on only stable patients (n = 921, 93 [10.1%]) (those without baseline hypoxemia ≤ 88%). Peri-intubation hypoxemia was associated with in-hospital mortality (OR 2.40, [95% CI 1.33, 4.31]; stable patients: OR 2.67, [95% CI 1.38, 5.17]) but not ICU length of stay (point estimate 0.9 days, [95% CI −1.0, 2.8 days]; stable patients: point estimate 1.5 days, [95% CI −0.4, 3.4 days]) after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline SPO2. Conclusions: Patients with pre-existing noninvasive ventilation and volume loading who were intubated emergently in the setting of hemodynamic compromise with bag-mask ventilation described as moderate-severe were at increased risk for peri-intubation hypoxemia. Higher baseline oxygenation was found to be protective against peri-intubation hypoxemia. Peri-intubation hypoxemia was associated with in-hospital mortality but not ICU length of stay. Trial registration: Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

Smischney

Khanna

Brauer

et al. 2020

J Intensive Care Med

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“…The strategy for preoxygenation of a patient with severe pneumonia or acute respiratory distress syndrome (ARDS) should be different from a patient who requires intubation but does not present with significant respiratory pathology. Preoxygenation can be very challenging, especially when patients require intubation for acute hypoxemic respiratory failure after failing noninvasive strategies, such as noninvasive positive pressure ventilation (NIPPV) or high flow nasal oxygen (HFNO) [ 8 , 9 ]. Patients that fail NIPPV and require intubation have, at best, modest increases in the partial pressure of arterial oxygen (PaO2) when preoxygenated with the traditional practice of breathing 100% oxygen for 4 min [ 10 ].…”

Section: Preoxygenationmentioning

confidence: 99%

Airway Management in the Critically Ill Patient

Mosier

2021

Curr Anesthesiol Rep

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Purpose of Review This paper will evaluate the recent literature and best practices in airway management in critically ill patients. Recent Findings Cardiac arrest remains a common complication of intubation in these high-risk patients. Patients with desaturation or peri-intubation hypotension are at high risk of cardiac arrest, and each of these complications have been reported in up to half of all intubations in critically ill patient populations. Summary There have been significant advances in preoxygenation and devices available for performing laryngoscopy and rescue oxygenation. However, the risk of cardiovascular collapse remains concerningly high with few studies to guide therapeutic maneuvers to reduce this risk.

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Complications of Airway Management

Shetty

Mohanraj

2023

The Airway Manual

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Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

Cited by 12 publications

References 30 publications

Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

Airway Management in the Critically Ill Patient

Complications of Airway Management

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