TABLE 2.
Procedural Management
| Variables | Overall Cohort | Propensity-Matched Cohort | ||||
|---|---|---|---|---|---|---|
| Vasopressora (n = 187) | No Vasopressor (n = 1,611) | p | Vasopressora (n = 187) | No Vasopressor (n = 187) | p | |
| Intubation location | < 0.001 | 0.80 | ||||
| Emergency department | 41 (22%) | 575 (36%) | 41 (22%) | 39 (21%) | ||
| ICU | 143 (77%) | 1,012 (63%) | 143 (77%) | 146 (78%) | ||
| Operator specialty | < 0.001 | 0.96 | ||||
| Emergency medicine | 45 (24%) | 617 (38%) | 45 (24%) | 46 (25%) | ||
| Critical care | 129 (69%) | 908 (56%) | 129 (69%) | 128 (68%) | ||
| Anesthesiology | 11 (6%) | 60 (4%) | 11 (6%) | 9 (5%) | ||
| Other | 2 (1%) | 23 (1%) | 2 (1%) | 3 (2%) | ||
| Operator level of training | 0.35 | 0.10 | ||||
| Resident/fellow | 171 (91%) | 1,420 (88%) | 171 (91%) | 160 (86%) | ||
| Attending physician | 9 (5%) | 84 (5%) | 9 (5%) | 10 (5%) | ||
| Advanced practice providerb | 7 (4%) | 104 (7%) | 7 (4%) | 17 (9%) | ||
| Operator previous intubation experience | 50 (30–90) | 55 (30–90) | 0.88i | 50 (30–90) | 50 (30–80) | 0.54i |
| Baseline oxygen saturation (%)c | 99 (94.5–100) | 100 (97–100) | 0.004i | 99 (94.5–100) | 99 (95–100) | 0.29i |
| Pre-induction oxygenation | 0.71 | 0.74 | ||||
| High-flow nasal cannula | 31 (17%) | 240 (15%) | 31 (17%) | 30 (16%) | ||
| Bilevel positive pressure ventilation | 44 (24%) | 345 (21%) | 44 (24%) | 50 (27%) | ||
| Fio2 prior to intubation | 0.50 (0.24–0.90) | 0.50 (0.27–0.80) | 0.75i | 0.50 (0.24–0.80) | 0.50 (0.27–0.90) | 0.75i |
| Baseline systolic blood pressure (mm Hg)c | 110 ± 24 | 135 ± 30 | < 0.001h | 110 ± 24 | 111 ± 21 | 0.66h |
| Vasopressor infusion prior to enrollmentd | 103 (55%) | 167 (10%) | < 0.001 | 103 (55%) | 97 (52%) | 0.60 |
| Norepinephrine | 91 (49%) | 148 (9%) | 91 (49%) | 86 (46%) | ||
| Phenylephrine | 14 (8%) | 20 (1%) | 14 (8%) | 15 (8%) | ||
| Epinephrine | 10 (5%) | 16 (1%) | 10 (5%) | 9 (5%) | ||
| Dopamine | 1 (0.5%) | 1 (0.1%) | 1 (0.5%) | 0 (0%) | ||
| Angiotensin II | 2 (1%) | 2 (0.1%) | 2 (1%) | 2 (1%) | ||
| Induction agents | ||||||
| Propofol | 17 (9%) | 106 (7%) | 0.22 | 17 (9%) | 17 (9%) | > 0.99 |
| Etomidate | 134 (72%) | 1,168 (73%) | 0.80 | 134 (72%) | 131 (70%) | 0.82 |
| Ketamine | 35 (19%) | 312 (19%) | 0.92 | 35 (19%) | 33 (18%) | 0.89 |
| Bag-mask ventilation between induction and intubation | 118 (63%) | 878 (55%) | 0.03 | 118 (63%) | 114 (61%) | 0.75 |
| First-attempt successe | 157 (84%) | 1,346 (84%) | > 0.99 | 157 (84%) | 152 (81%) | 0.59 |
| Duration of intubation (s)f | 130 (96–190) | 129 (97–187) | 0.79i | 130 (96–190) | 120 (97–180) | 0.40i |
| Lowest oxygen saturation (%)g | 96 (87–100) | 97 (88–100) | 0.07i | 96 (87–100) | 96 (89–100) | 0.71i |
| Fluid bolus | ||||||
| Pre-induction (mL) | 63.5 (0–269) | 0 (0–250) | 0.22i | 63.5 (0–269) | 0 (0–300) | 0.44i |
| Total (mL) | 125 (0–500) | 7.5 (0–450) | 0.16i | 125 (0–500) | 2.5 (0–423) | 0.25i |
| Enrolled in BOUGIE (24) | 94 (50%) | 935 (58%) | 0.05 | 94 (50%) | 95 (51%) | > 0.99 |
| Enrolled in PREPARE II (25) | 127 (68%) | 933 (58%) | 0.009 | 127 (68%) | 125 (67%) | 0.91 |
BOUGIE = The Bougie or Stylet in Patients Undergoing Intubation Emergently trial, PREPARE II = Preventing Cardiovascular Collapse With Administration of Fluid Resuscitation During Induction and Intubation trial.
Prophylactic administration of vasopressor bolus or dose increase prior to or at induction.
Advanced practice providers included physician assistants, certified registered nurse anesthetists, and nurse practitioners.
Baseline peripheral arterial oxygen saturation and systolic blood pressure were measured at the time of induction.
Any vasopressor or inotropic infusion(s) in the hour prior to enrollment.
First-attempt success was defined as a single insertion of a laryngoscope blade into the mouth and passage of endotracheal tube into the trachea.
Time from induction to successful endotracheal tube placement in seconds.
Lowest peripheral arterial oxygen saturation recorded between induction and 2 min of successful intubation.
p value from t test.
p value from Wilcoxon rank-sum test.
Values are expressed as mean ± sd, median (interquartile range), and count (%).