Abstract
AbstractPurposeIntubation is a common procedure in acute hypoxemic respiratory failure (AHRF), with minimal evidence to guide decision-making. We conducted a survey of when to intubate patients with AHRF to measure the influence of clinical variables on intubation decision-making and quantify variability.MethodsWe developed an anonymous factorial vignette-based web survey to ask clinicians involved in the decision to intubate “Would you recommend intubation?” Respondents selected an ordinal recommendation from a 5-point scale ranging from “Definite no” to “Definite yes” for up to 10 randomly allocated vignettes. We disseminated the survey through clinical and academic societies, analyzed responses using Bayesian proportional odds modeling with clustering by individual, country, and region, and reported mean odds ratios (OR) with 95% credible intervals (CrI).ResultsBetween September 2023 and January 2024, 2,294 respondents entered 17,235 vignette responses in 74 countries [most common: Canada (29%), USA (26%), France (9%), Japan (8%), and Thailand (5%)]. Respondents were attending physicians (63%), nurses (13%), trainee physicians (9%), respiratory therapists (9%), other (6%). Lower oxygen saturation, higher inspired oxygen fraction, non-invasive ventilation compared to high-flow, tachypnea, neck muscle use, abdominal paradox, drowsiness, and inability to obey were associated with increased odds of intubation; diagnosis, vasopressors, and duration of symptoms were not. Within a country the odds of recommending intubation changed between clinicians by an average factor of 2.60, while changing between countries within a region changed it by 1.56.ConclusionIn this international, interprofessional survey of more than 2000 practicing clinicians, intubation for patients with AHRF was mostly decided based on oxygenation, breathing pattern, and consciousness, but there was important variation across individuals and countries.
Publisher
Cold Spring Harbor Laboratory