TY - JOUR
T1 - An International Factorial Vignette-Based Survey of Intubation Decisions in Acute Hypoxemic Respiratory Failure
AU - Yarnell, Christopher J.
AU - Paranthaman, Arviy
AU - Reardon, Peter
AU - Angriman, Federico
AU - Bassi, Thiago
AU - Bellani, Giacomo
AU - Brochard, Laurent
AU - De Grooth, Harm Jan
AU - Dragoi, Laura
AU - Gaus, Syafruddin
AU - Glover, Paul
AU - Goligher, Ewan C.
AU - Lewis, Kimberley
AU - Li, Baoli
AU - Kareemi, Hashim
AU - Vijayaraghavan, Bharath Kumar Tirupakuzhi
AU - Mehta, Sangeeta
AU - Mellado-Artigas, Ricard
AU - Moore, Julie
AU - Morris, Idunn
AU - Roman-Sarita, Georgiana
AU - Pham, Tai
AU - Sereeyotin, Jariya
AU - Tomlinson, George
AU - Wozniak, Hannah
AU - Yoshida, Takeshi
AU - Fowler, Rob
N1 - Publisher Copyright:
Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2025/1
Y1 - 2025/1
N2 - OBJECTIVES: Intubation 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. DESIGN: Factorial vignette-based survey asking “Would you recommend intubation?” Respondents selected an ordinal recommendation from a 5-point scale ranging from “Definite no” to “Definite yes” for up to ten randomly allocated vignettes. We used Bayesian proportional odds modeling, with clustering by individual, country, and region, to calculate mean odds ratios (ORs) with 95% credible intervals (CrIs). SETTING: Anonymous web-based survey. SUBJECTS: Clinicians involved in the decision to intubate. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Between September 2023 and January 2024, 2,294 respondents entered 17,235 vignette responses in 74 countries (most common: Canada [29%], United States [26%], France [9%], Japan [8%], and Thailand [5%]). Respondents were attending physicians (63%), nurses (13%), trainee physicians (9%), respiratory therapists (9%), and other (6%). Lower oxygen saturation, higher Fio2, noninvasive ventilation compared with 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. Nurses were less likely than physicians to recommend intubation. Within a country, the odds of recommending intubation changed between clinicians by an average factor of 2.60; within a region, the same odds changed between countries by 1.56. Respondents from Canada (OR, 0.53; CrI, 0.40–0.70) and the United States (OR, 0.63; CrI, 0.48–0.84) were less likely to recommend intubation than respondents from most other countries. CONCLUSIONS: In this international, multiprofessional survey of 2294 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.
AB - OBJECTIVES: Intubation 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. DESIGN: Factorial vignette-based survey asking “Would you recommend intubation?” Respondents selected an ordinal recommendation from a 5-point scale ranging from “Definite no” to “Definite yes” for up to ten randomly allocated vignettes. We used Bayesian proportional odds modeling, with clustering by individual, country, and region, to calculate mean odds ratios (ORs) with 95% credible intervals (CrIs). SETTING: Anonymous web-based survey. SUBJECTS: Clinicians involved in the decision to intubate. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Between September 2023 and January 2024, 2,294 respondents entered 17,235 vignette responses in 74 countries (most common: Canada [29%], United States [26%], France [9%], Japan [8%], and Thailand [5%]). Respondents were attending physicians (63%), nurses (13%), trainee physicians (9%), respiratory therapists (9%), and other (6%). Lower oxygen saturation, higher Fio2, noninvasive ventilation compared with 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. Nurses were less likely than physicians to recommend intubation. Within a country, the odds of recommending intubation changed between clinicians by an average factor of 2.60; within a region, the same odds changed between countries by 1.56. Respondents from Canada (OR, 0.53; CrI, 0.40–0.70) and the United States (OR, 0.63; CrI, 0.48–0.84) were less likely to recommend intubation than respondents from most other countries. CONCLUSIONS: In this international, multiprofessional survey of 2294 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.
KW - acute hypoxemic respiratory failure
KW - endotracheal intubation
KW - healthcare surveys
KW - multilevel analyses
UR - http://www.scopus.com/inward/record.url?scp=85210769305&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000006494
DO - 10.1097/CCM.0000000000006494
M3 - Article
C2 - 39576153
AN - SCOPUS:85210769305
SN - 0090-3493
VL - 53
SP - e117-e131
JO - Critical care medicine
JF - Critical care medicine
IS - 1
ER -