[Severe complications of orotracheal intubation in the Intensive Care Unit: An observational study and analysis of risk factors]. / Complicaciones graves en la intubación orotraqueal en cuidados intensivos: estudio observacional y análisis de factores de riesgo.

ABSTRACT

OBJECTIVE: A study is made to determine the characteristics of endotracheal intubation (ETI) procedures performed in an Intensive Care Unit, and to describe the associated severe complications and related risk factors. DESIGN: A prospective cohort study involving a 2-year period was carried out. SETTING: The combined clinical/surgical Intensive Care Unit in a secondary university hospital. PATIENTS All ETIs carried out by intensivists were included. INTERVENTIONS: None. MAIN VARIABLES We analyzed the data associated with the patient, the procedure and the postoperative complications after intubation. The study of risk factors was performed using multiple logistic regression analysis. RESULTS: Seventy-six percent of the ETIs were performed immediately. Most of them were carried out by Intensive Care Units residents (60%). A total of 34% of the procedures had severe complications, including respiratory (16%) or hemodynamic (5%) disorders, or both (10%). Three patients died (1%), and 2% of the subjects experienced cardiac arrest. Logistic regression analysis identified the following independent risk factors for complications age (OR 1.1; 95% CI 1.1-1.2), systolic blood pressure≤90mmHg (OR 3.0; 95% CI 1.4-6.4) and SpO2≤90% (OR 4.4; 95% CI 2.3-8.1) prior to intubation, the presence of secretions (OR 2.2; 95% CI 1.1-4.6), and the need for more than one ETI attempt (OR 3.5; 95% CI 1.4-8.7). CONCLUSIONS: ETI in Intensive Care Unit patients is associated with respiratory and hemodynamic complications. The independent risk factors associated with the development of complications were advanced age, hypotension and previous hypoxemia, the presence of secretions, and the need for more than one ETI attempt.