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To determine if smaller endotracheal tubes are noninferior to larger endotracheal tubes with respect to critical illness outcomes. DESIGN, SETTING, AND PARTICIPANTSThis propensity score-matched retrospective cohort study included all adult patients who underwent endotracheal intubation in the emergency department or intensive care unit and received mechanical ventilation for at least 12 hours from June 2020 to November 2020 at a single tertiary referral academic medical center. EXPOSURES Endotracheal intubation.MAIN OUTCOMES AND MEASURES Propensity score-matched analyses were performed with respect to the primary end point of 30-day all-cause in-hospital survival as well as the secondary end points of duration of invasive mechanical ventilation, length of hospital stay, mean peak inspiratory pressure, 30-day readmission, need for reintubation, and need for tracheostomy or gastrostomy tube placement.RESULTS Overall, 523 participants (64%) were men and 291 (36%) were women. Of these, 814 patients were categorized into 3 endotracheal tube groups: small for height (n = 182), appropriate for height (n = 408), and large for height (n = 224). There was not a significant difference in 30-day all-cause in-hospital survival between groups ([HR, 1.1; 95% CI, 0.7-1.7] for small vs appropriate; [HR, 1.1; 95% CI, 0.7-1.6] for large vs appropriate). Patients with small-for-height endotracheal tubes had longer intubation durations (mean difference, 32.5 hrs [95% CI, 6.4-58.6 hrs]) compared with patients with appropriate-for-height tubes.CONCLUSIONS AND RELEVANCE Despite differences in intubation duration, the results of this cohort study suggest that smaller endotracheal tube sizes are not associated with impaired survival or recovery from critical illness. They support future prospective exploration of the association of smaller endotracheal tube sizes with recovery from critical illness.

For critically ill adults, oxygen saturation is continuously monitored using pulse oximetry (Spo 2 ) as a surrogate for arterial oxygen saturation (Sao 2 ). Skin pigmentation may affect accuracy of Spo 2 by introducing error from statistical bias, variance, or both. We evaluated relationships between race, Spo 2 , Sao 2 , and hypoxemia (Sao 2 < 88%) or hyperoxemia (Pao 2 > 150 mm Hg) among adults receiving mechanical ventilation in a medical ICU. DESIGN:Single-center, observational study. SETTING: Medical ICU at an academic medical center.PATIENTS: Critically ill adults receiving mechanical ventilation from July 2018 to February 2021, excluding patients with COVID-19, with race documented as Black or White in the electronic medical record, who had a pair of Spo 2 and Sao 2 measurements collected within 10 minutes of each other. INTERVENTIONS:None. MEASUREMENTS:We included 1,024 patients with 5,557 paired measurements within 10 minutes, of which 3,885 (70%) were within 1 minute. Of all pairs, 769 (14%) were from Black patients and 4,788 (86%) were from White patients. In analyses using a mixed-effects model, we found that across the range of Spo 2 values of 92-98%, the associated Sao 2 value was approximately 1% point lower for Black patients compared with White patients. Among patients with a Spo 2 value between 92% and 96%, Black patients were more likely to have both hypoxemia (3.5% vs 1.1%; p = 0.002) and hyperoxemia (4.7% vs 2.4%; p = 0.03), compared with White patients.CONCLUSIONS: Among patients with a measured Spo 2 of 92-96%, greater variation in Sao 2 values at a given Spo 2 resulted in a higher occurence rate of both hypoxemia and hyperoxemia for Black patients compared with White patients.