title: Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  clinicaltrials.gov NCT01532063 ; registered 8 February 2012.
authors.affiliation: Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. sperbet@chu-clermontferrand.fr.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Perbet
authors.affiliation: Anesthesiology and Critical Care Medicine, Department B, Saint Eloi Hospital, University Hospital of Montpellier, INSERM U1046, Montpellier, France. audreydejong@hotmail.fr.
authors.forename: Audrey
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. j_delmas@chu-clermontferrand.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Delmas
authors.affiliation: Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. efutier@chu-clermontferrand.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Futier
authors.affiliation: Biostatistics Unit (Department of Clinical Research and Innovation), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. bpereira@chu-clermontferrand.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Anesthesiology and Critical Care Medicine, Department B, Saint Eloi Hospital, University Hospital of Montpellier, INSERM U1046, Montpellier, France. s-jaber@chu-montpellier.fr.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. jmconstantin@chu-clermontferrand.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
mesh_terms: D018806:APACHE; D000367:Age Factors; D000368:Aged; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D010101:Oxygen Consumption; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy; D012307:Risk Factors; D012769:Shock / Q000209:etiology*