title: Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study.
abstract: 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.
authors.affiliation: Intensive Care Unit, Department of Anesthesiology B, DAR B CHU de Montpellier, Hôpital Saint Eloi, Université Montpellier 1, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Jibba
authors.initials: J
authors.lastname: Amraoui
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Charles
authors.initials: C
authors.lastname: Arich
authors.forename: Robert
authors.initials: R
authors.lastname: Cohendy
authors.forename: Liliane
authors.initials: L
authors.lastname: Landreau
authors.forename: Yves
authors.initials: Y
authors.lastname: Calvet
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
authors.forename: Aba
authors.initials: A
authors.lastname: Mahamat
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Eledjam
mesh_terms: 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