A Nationwide, Prospective Study of Tracheal Intubation in Critically Ill Adults in Spain: Management, Associated Complications, and Outcomes.

OBJECTIVES: Our aims were to explore current intubation practices in Spanish ICUs to determine the incidence and risk factors of peri-intubation complications (primary outcome measure: major adverse events), the rate and factors associated with first-pass success, and their impact on mortality as well as the changes of the intubation procedure observed in the COVID-19 pandemic. DESIGN: Prospective, observational, and cohort study. SETTING: Forty-three Spanish ICU. PATIENTS: A total of 1837 critically ill adult patients undergoing tracheal intubation. The enrollment period was six months (selected by each center from April 16, 2019, to October 31, 2020). INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: At least one major adverse peri-intubation event occurred in 40.4 % of the patients (973 major adverse events were registered) the most frequent being hemodynamic instability (26.5%) and severe hypoxemia (20.3%). The multivariate analysis identified seven variables independently associated with a major adverse event whereas the use of neuromuscular blocking agents (NMBAs) was associated with reduced odds of major adverse events. Intubation on the first attempt was achieved in 70.8% of the patients. The use of videolaryngoscopy at the first attempt was the only protective factor (odds ratio 0.43; 95% CI, 0.28-0.66; p < 0.001) for first-attempt intubation failure. During the COVID-19 pandemic, the use of videolaryngoscopy and NMBAs increased significantly. The occurrence of a major peri-intubation event was an independent risk factor for 28-day mortality. Cardiovascular collapse also posed a serious threat, constituting an independent predictor of death. CONCLUSIONS: A major adverse event occurred in up to 40% of the adults intubated in the ICU. Peri-intubation hemodynamic instability but not severe hypoxemia was identified as an independent predictor of death. The use of NMBAs was a protective factor for major adverse events, whereas the use of videolaringoscopy increases the first-pass success rate of intubation. Intubation practices changed during the COVID-19 pandemic.

Complicaciones infecciosas de la ventilación mecánica. Necesidad de estrategias de prevención / Mechanic ventilation complicated with infections: Need of preventive measures

Hemos leído con gran interés el artículo de Varón-Vega FA et al "Traqueobronquitis y neumonía asociada a ventilación mecánica en unidades de cuidado intensivo de Latinoamérica: epidemiología, curso clínico y desenlaces (estudio LATINAVE)" Es conocido que la neumonía asociada a ventilación mecánica (NAVM) se relaciona con un incremento de la estancia en las Unidades de Cuidados Intensivos (UCI) y en el hospital, mayor consumo de antibióticos, un alargamiento de la duración de la ventilación mecánica y un aumento de la mortalidad bruta y atribuida

We have read with great interest the article by Varón-Vega FA et al "Tracheobronchitis and ventilator-associated pneumonia in intensive care units in Latin America: epidemiology, clinical course and outcomes (LATINAVE study)" It is known that ventilator-associated pneumonia (VAP) is associated with an increase in intensive care unit (ICU) and hospital stay, higher antibiotic consumption, a lengthening of the duration of mechanical ventilation and an increase in crude and attributed mortality.