Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study

Darreau, Cédric; Martino, Frédéric; Saint-Martin, Marjorie; Jacquier, Sophie; Hamel, Jean François; Nay, Mai-Anh; Terzi, Nicolas; Ledoux, G.; Roche-Campo, Ferrán; Camous, Laurent; Pène, Frédéric; Balzer, Thibault; Bagate, François; Lorber, Jonathan; Bouju, Pierre; Marois, Clémence; Robert, René; Gaudry, Stéphane; Commereuc, Morgane; Débarre, Matthieu; Chudeau, Nicolas; Labroca, Pierre; Merouani, Karim; Egreteau, Pierre-Yves; Peigne, Vincent; Bornstain, Caroline; Lebas, Eddy; Bénézit, François; Vally, S.; Lasocki, Sigismond; Robert, Alexandre; Delbove, Agathe; Lerolle, Nicolas

doi:10.1186/s13613-020-00668-6

Cited by 40 publications

(45 citation statements)

References 28 publications

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“…For example, after tracheal intubation in patients with type II respiratory failure, ETCO 2 is signi cantly increased due to the accumulation of carbon dioxide in the body. At this time, the value of ETCO 2 may not truly re ect the changes in circulation [20].…”

Section: Discussionmentioning

confidence: 97%

The Predictive Value of MAP and ETCO2 Changes After Emergency Endotracheal Intubation for Severe Cardiovascular Collapse

Dai

Song

et al. 2020

Preprint

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Objective: To analyze the changes in mean arterial pressure (MAP) and end-tidal CO2 (ETCO2) in patients after emergency endotracheal intubation (ETI). To explore the values of MAP and ETCO2 monitoring in the early prediction of severe cardiovascular collapse (CVC). Methods: The clinical data of patients who underwent ETI were collected. The values of both MAP and ETCO2 were observed and recorded at 5 minutes, 10 minutes, 30 minutes, 60 minutes and 120 minutes post intubation. According to whether severe CVC occurred after ETI, the patients were divided into a severe CVC group and a non-severe CVC group. The values of MAP and ETCO2 were compared at the same time points. The correlation between MAP and ETCO2 after ETI was also analyzed. receiver operating characteristic curves(ROC curves) were used to analyze the ability of MAP and ETCO2 at 5 minutes and 10 minutes after ETI to predict severe CVC.Results: A total of 116 patients were enrolled in this study; among them, 75 (64.7%) had severe CVC after ETI. The majority of subjects in the severe CVC group were male and elderly patients. The values of MAP and ETCO2 at 5 minutes, 10 minutes, 30 minutes, 60 minutes and 120 minutes after ETI in the severe CVC group were significantly lower than those in the non-severe group. Both MAP and ETCO2 in the two groups showed simultaneous decreases from 5 minutes to 30 minutes after ETI, reaching their lowest values at 30 minutes after ETI. After ETI, the changes in MAP were correlated with those in ETCO2 (rs = 0.653, P < 0.001). At 5 minutes after ETI, MAP could predict severe CVC (AUC = 0.86, P < 0.001), MAP≤72 mmHg was the best cutoff value (sensitivity 78.7%, specificity 87.8%), and ETCO2 could also predict severe CVC (AUC = 0.85, P < 0.001). ETCO2≤35 mmHg was the best cutoff value for predicting severe CVC (sensitivity 77.3%, specificity 85.4%). At 10 minutes after ETI, MAP could predict severe CVC (AUC = 0.90, P < 0.001), MAP≤67 mmHg was the best cutoff value (sensitivity 89.3%, specificity 85.4%), and ETCO2 could also predict severe CVC (AUC = 0.87, P < 0.001). ETCO2≤33 mmHg was the best cutoff value for predicting severe CVC (sensitivity 81.3%, specificity 78%). There was no significant difference in the predictive ability between any two cutoff values of MAP or ETCO2 at 5 minutes and 10 minutes after ETI (P >0.05). Conclusion: Both MAP and ETCO2 values of the patients with severe CVC were significantly lower than those of patients without severe CVC from 5 minutes to 120 minutes after ETI, reaching their lowest values at 30 minutes after ETI. MAP and ETCO2 values changed synchronously with the time after intubation. There was a positive correlation between MAP and ETCO2 after ETI. MAP and ETCO2 values in the early stage after ETI have high accuracy in predicting severe CVC.

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Section: Discussionmentioning

confidence: 97%

The Predictive Value of MAP and ETCO2 Changes After Emergency Endotracheal Intubation for Severe Cardiovascular Collapse

Dai

Song

et al. 2020

Preprint

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“…Finally, our mixed-effects analysis showed that most of the variability for the need of invasive mechanical ventilation can be explained by baseline factors at admission, while differential "ICU culture" does not appear to play a major role in this decision. This needs to be analysed in comparison to previous research showing fairly strong centre effects, both in the care of patients with septic shock and mechanically ventilated critically ill adults 17,34 .…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, several studies have shown that the use of invasive mechanical ventilation remains high in patients with COVID-19, and patients usually receive it for long periods of time [13][14][15] . Although the decision to intubate is based on several clinical markers, including blood oxygenation 16 , ICUs may have different policies towards the initiation of invasive mechanical ventilation 17 . Based on experimental 18,19 and observational data 4,5 , a so-called "early approach" to invasive mechanical ventilation is advocated by some experts in patients with non-COVID-19 related ARDS 4 .…”

Section: Introductionmentioning

confidence: 99%

Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicentre observational study

Artigas

Mujica

Ruiz

et al. 2020

Preprint

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Purpose We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation. Methods This is a multicentre, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated. Results From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41–2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37–0.72), and pH (OR 0.47; 95% CI: 0.24–0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95%CI 0.80–0.96). Conclusions Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.

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“…Patients were included if they had positive con rmatory nasopharyngeal or pulmonary tract sample and received support with either HFNO or intubation on the rst day of ICU admission. Main exclusion criteria were intubation outside the ICU, a PaO /FiO 2 ratio > 300 mmHg, a respiratory rate on day 1 above 35 breaths/min, a Glasgow Coma Score lower than 13 and pH lower than 7.25 18,27 . The rationale for the aforementioned eligibility criteria was based on a population that (with equipoise) could theoretically be randomized to a strategy of early intubation or HFNO in the rst 24 hours of critical illness, under the framework of a target randomized trial (e-table 1).…”

Section: Study Populationmentioning

confidence: 99%

“…Conversely, several studies have shown that the use of invasive mechanical ventilation remains high in this population, and patients usually receive it for prolonged periods of time [14][15][16] . In daily clinical practice, the decision to intubate is usually based on several clinical markers -including blood oxygenation 17 -and may differ across institutions 18 .…”

Section: Introductionmentioning

confidence: 99%

High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

Artigas

Ferreyro

Angriman

et al. 2020

Preprint

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Purpose Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high flow nasal oxygen on ventilator free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units. Main exposure was the use of high flow nasal oxygen (conservative group), while early invasive mechanical (within the first day of critical care admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. Intensive care unit length of stay and all-cause in hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results A total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in intensive care unit length of stay (mean difference: -8.2 days; 95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). Conclusions The use of high flow nasal oxygen upon intensive care admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in intensive care unit length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

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Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study

Cited by 40 publications

References 28 publications

The Predictive Value of MAP and ETCO2 Changes After Emergency Endotracheal Intubation for Severe Cardiovascular Collapse

The Predictive Value of MAP and ETCO2 Changes After Emergency Endotracheal Intubation for Severe Cardiovascular Collapse

Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicentre observational study

High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

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