A Nationwide, Prospective Study of Tracheal Intubation in Critically Ill Adults in Spain: Management, Associated Complications, and Outcomes

Background. Intubation in the intensive care unit (ICU) is always a risky procedure despite the introduction of new technological advances. Our aims were to explore the current practices of intubation in Spanish ICU, to determine the incidence and risk factors of peri-intubation events, the rate and factors associated with first-pass success, and the impact on mortality.Methods. Nationwide, prospective cohort study that included critically ill adult patients undergoing tracheal intubation. The enrollment period was 6 months (selected by each center from April 15, 2019, to October 31, 2020). The primary outcome measure was the incidence of peri-intubation major adverse events. The secondary outcome measures included non-major complications, factors associated with first-pass orotracheal intubation and mortality.Findings. 1837 critically ill patients. Respiratory failure (60.6%), coma (18.7%), and hemodynamic instability (6.8%) were the main reasons for intubation. At least 1 peri-intubation major adverse event occurred in 40.4 % of the patients (973 major complications were registered) being hemodynamic instability (26.5%) and severe hypoxemia (20.3%) the most frequent. The multivariate analysis identified eight variables independently associated with mortality whereas coma and the use of muscle relaxants were protective factors. Intubation on the first attempt was in achieved 70.8% of the patients. The occurrence of a peri-intubation major event was an independent risk factor for mortality.Interpretation. Endotracheal intubation in critically ill patients is associated with a high rate of potentially life-threatening complications occurring in up to 40% of the patients which is associated with higher likelihood of death during hospitalization.Funding: None.Declaration of Interests: The authors declare no conflicts of interestEthics Approval Statement: The ethics committee of the coordinating center (Virgen Macarena University Hospital, January 14, 2019) approved this study. All participating centers also obtained local ethics committee approval.