Peri-intubation Cardiovascular Collapse in Critically Ill Patients: Insights from the INTUBE Study

Rationale Cardiovascular instability/collapse is a common peri-intubation event in critically ill patients. Objectives To identify potentially modifiable variables associated with peri-intubation cardiovascular instability/collapse. Methods INTUBE was a multicenter prospective cohort study of critically ill patients undergoing tracheal intubation in a convenience sample of 197 sites from 29 countries from October 2018 to July 2019. Results Peri-intubation cardiovascular instability/collapse occurred in 1199 out of 2760 patients (43.4%). Variables associated with this event were older age (OR 1.02, 95% CI 1.02 - 1.03), higher heart rate (OR 1.008, 95% CI 1.004 - 1.012), lower systolic blood pressure (OR 0.98, 95% CI 0.98 - 0.99), lower SpO2/FiO2 before induction (OR 0.998, 95% CI 0.997 - 0.999) and the use of propofol as an induction agent (OR 1.28, 95% CI 1.05 - 1.57). Patients with peri-intubation cardiovascular instability/collapse were at higher risk of ICU mortality with an adjusted OR of 2.47 (95% CI 1.72 - 3.55), p < 0.001. The inverse probability of treatment weighting method identified the use of propofol as the only factor independently associated with cardiovascular instability/collapse (OR 1.23, 95% CI 1.02 - 1.49). When administered before induction, vasopressors (OR 1.33, 95% CI 0.84 - 2.11) or fluid boluses (OR 1.17, 95% CI 0.96 - 1.44) did not reduce the incidence of cardiovascular instability/collapse. Conclusions Peri-intubation cardiovascular instability/collapse was associated with an increased risk of both ICU and 28-day mortality. Use of propofol for induction was identified as a modifiable intervention significantly associated with cardiovascular instability/collapse.