(1378) Tracheal Intubation and Increased Mortality in Patients With Acute Respiratory Failure

Introduction: Tracheal intubation is a high-risk procedure commonly performed in critically ill patients with acute respiratory failure (ARF). Epidemiological data on its performance at a national level, and impact on mortality is lacking, prompting wide variation in use.

Methods: This was an observational cohort study of adult hospitalizations (2016-2020) for ARF using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of critically ill patients with ARF who underwent tracheal intubation and assessed the trends in the performance of tracheal intubation, as well as mortality associated with this procedure over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics.

Results: A total of 2,531,420 ARF-related hospitalizations were identified during the study period, of whom 522,746 746 (20.7%) underwent tracheal intubation. The number of patients with ARF increased from 332,638 cases in 2016 to 740,925 cases in 2020. However, the proportion of patients with acute respiratory failure who received tracheal intubation significantly decreased from 23.9% to 18.9% during the study period (p < 0.0001). Mortality rates were significantly higher for intubated patients throughout all the study years. Mortality rates remained relatively stagnant in non-intubated patients, varying from 8.1% in 2016 to 8.0% in 2020 (p for trend = 0.197). In contrast, mortality in intubated patients significantly increased from 30.6% in 2016 to 37.9% in 2020 (p for trend < 0.0001). Hierarchical regression analysis revealed that the hospital where the patient received care explained 8.3% of the variability in tracheal intubation rates in patients with ARF.

Conclusions: Performance of tracheal intubation in critically ill patients with ARF has decreased over time but continues to be associated with significant mortality. The large variation in performance of tracheal intubation across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from tracheal intubation.