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Darreau C, Martino F, Saint-Martin M, Jacquier S, Hamel JF, Nay MA, Terzi N, Ledoux G, Roche-Campo F, Camous L, Pene F, Balzer T, Bagate F, Lorber J, Bouju P, Marois C, Robert R, Gaudry S, Commereuc M, Debarre M, Chudeau N, Labroca P, Merouani K, Egreteau PY, Peigne V, Bornstain C, Lebas E, Benezit F, Vally S, Lasocki S, Robert A, Delbove A, Lerolle N. Use, timing and factors associated with tracheal intubation in septic shock: a prospective multicentric observational study. Ann Intensive Care 2020; 10:62. [PMID: 32449053 PMCID: PMC7245631 DOI: 10.1186/s13613-020-00668-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background No recommendation exists about the timing and setting for tracheal intubation and mechanical ventilation in septic shock. Patients and methods This prospective multicenter observational study was conducted in 30 ICUs in France and Spain. All consecutive patients presenting with septic shock were eligible. The use of tracheal intubation was described across the participating ICUs. A multivariate analysis was performed to identify parameters associated with early intubation (before H8 following vasopressor onset). Results Eight hundred and fifty-nine patients were enrolled. Two hundred and nine patients were intubated early (24%, range 4.5–47%), across the 18 centers with at least 20 patients included. The cumulative intubation rate during the ICU stay was 324/859 (38%, range 14–65%). In the multivariate analysis, seven parameters were significantly associated with early intubation and ranked as follows by decreasing weight: Glasgow score, center effect, use of accessory respiratory muscles, lactate level, vasopressor dose, pH and inability to clear tracheal secretions. Global R-square of the model was only 60% indicating that 40% of the variability of the intubation process was related to other parameters than those entered in this analysis. Conclusion Neurological, respiratory and hemodynamic parameters only partially explained the use of tracheal intubation in septic shock patients. Center effect was important. Finally, a vast part of the variability of intubation remained unexplained by patient characteristics. Trial registration Clinical trials NCT02780466, registered on May 23, 2016. https://clinicaltrials.gov/ct2/show/NCT02780466?term=intubatic&draw=2&rank=1.
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Affiliation(s)
- C Darreau
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - F Martino
- Medical and Surgical Intensive Care Unit, Guadeloupe University Hospital, Les Abymes, Guadeloupe, France
| | - M Saint-Martin
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - S Jacquier
- Medical Intensive Care Unit, Tours University Hospital, Tours, France
| | - J F Hamel
- Methodology and Statistics Department, Angers University Hospital, Angers, France
| | - M A Nay
- Medical Intensive Care Unit, Orleans Regional Hospital, Orléans, France
| | - N Terzi
- Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France
| | - G Ledoux
- Medical and Surgical Intensive Care Unit, Lille University Hospital, Lille, France
| | - F Roche-Campo
- Intensive Care Unit, Hospital Verge de la Cinta, Tortosa, Spain
| | - L Camous
- Medical Intensive Care Unit, Bicêtre Hospital, AP-HP, Paris, France
| | - F Pene
- Medical Intensive Care Unit, Cochin Hospital, AP-HP, Paris, France
| | - T Balzer
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - F Bagate
- Medical Intensive Care Unit, Henri Mondor Hospital, AP-HP, Paris, France
| | - J Lorber
- Medical and Surgical Intensive Care Unit, La-Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - P Bouju
- Medical and Surgical Intensive Care Unit, Sud Bretagne Hospital, Lorient, France
| | - C Marois
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
| | - R Robert
- Medical Intensive Care Unit, Poitiers University Hospital, Poitiers, France
| | - S Gaudry
- Medical Intensive Care Unit, Louis Mourier Hospital, AP-HP, Colombes, France
| | - M Commereuc
- Medical Intensive Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - M Debarre
- Medical and Surgical Intensive Care Unit, Saint Brieuc Hospital, Saint Brieuc, France
| | - N Chudeau
- Medical and Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France
| | - P Labroca
- Medical Intensive Care Unit, Nancy University Central Hospital, Nancy, France
| | - K Merouani
- Medical and Surgical Intensive Care Unit, Alençon Hospital, Alençon, France
| | - P Y Egreteau
- Medical and Surgical Intensive Care Unit, Morlaix Hospital, Morlaix, France
| | - V Peigne
- Medical and Surgical Intensive Care Unit, Métropole Savoie Hospital, Chambéry, France
| | - C Bornstain
- Medical Intensive Care Unit, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - E Lebas
- Medical and Surgical Intensive Care Unit, Bretagne Atlantique Hospital, Vannes, France
| | - F Benezit
- Medical and Surgical Intensive Care Unit, Rennes University Hospital, Rennes, France
| | - S Vally
- Medical and Surgical Intensive Care Unit, Martinique University Hospital, Fort-de-France, Martinique, France
| | - S Lasocki
- Surgical Intensive Care Unit, Angers University Hospital, Angers, France
| | - A Robert
- Medical Intensive Care Unit, Nice University Hospital, Nice, France
| | - A Delbove
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - N Lerolle
- Medical Intensive Care Unit, Angers University Hospital, Angers, France.
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