Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study.
OBJECTIVE
To describe the current practice of physicians, to report complications associated with endotracheal intubation (ETI) performed in THE intensive care unit (ICU), and to isolate predictive factors of immediate life-threatening complications.


METHODS
Multiple-center observational study.


METHODS
Seven intensive care units of two university hospitals.


METHODS
: We evaluated 253 occurrences of ETI in 220 patients.


METHODS
From January 1 to June 30, 2003, data related to all ETI performed in ICU were collected. Information regarding patient descriptors, procedures, and immediate complications were analyzed.


RESULTS
The main indications to intubate the trachea were acute respiratory failure, shock, and coma. Some 148 ETIs (59%) were performed by residents. At least one severe complication occurred in 71 ETIs (28%): severe hypoxemia (26%), hemodynamic collapse (25%), and cardiac arrest (2%). The other complications were difficult intubation (12%), cardiac arrhythmia (10%), esophageal intubation (5%), and aspiration (2%). Presence of acute respiratory failure and the presence of shock as an indication for ETI were identified as independent risk factors for occurrence of complications, and ETI performed by a junior physician supervised by a senior (i.e., two operators) was identified as a protective factor for the occurrence of complications.


CONCLUSIONS
ETI in ICU patients is associated with a high rate of immediate and severe life-threatening complications. Independent risk factors of complication occurrence were presence of acute respiratory failure and presence of shock as an indication for ETI. Further studies should aim to better define protocols for intubation in critically ill patients to make this procedure safer.
Jaber
Samir
S
Intensive Care Unit, Department of Anesthesiology B, DAR B CHU de Montpellier, Hôpital Saint Eloi, Université Montpellier 1, France.
Amraoui
Jibba
J
Lefrant
Jean-Yves
JY
Arich
Charles
C
Cohendy
Robert
R
Landreau
Liliane
L
Calvet
Yves
Y
Capdevila
Xavier
X
Mahamat
Aba
A
Eledjam
Jean-Jacques
JJ
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001794:Blood Pressure; D002983:Clinical Competence; D003128:Coma / Q000150:complications / Q000628:therapy*; D004947:Esophagus; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007362:Intensive Care Units; D007440:Intubation; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D012769:Shock / Q000150:complications / Q000628:therapy*; D013599:Systole