• Christopher J Yarnell, Arviy Paranthaman, Peter Reardon, Federico Angriman, Thiago Bassi, Giacomo Bellani, Laurent Brochard, Harm Jan De Grooth, Laura Dragoi, Syafruddin Gaus, Paul Glover, Ewan C Goligher, Kimberley Lewis, Baoli Li, Hashim Kareemi, Bharath Kumar Tirupakuzhi Vijayaraghavan, Sangeeta Mehta, Ricard Mellado-Artigas, Julie Moore, Idunn Morris, Georgiana Roman-Sarita, Tai Pham, Jariya Sereeyotin, George Tomlinson, Hannah Wozniak, Takeshi Yoshida, Rob Fowler, and Canadian Critical Care Trials Group.
• Department of Critical Care Medicine, Scarborough Health Network, Toronto, ON, Canada.
• Crit. Care Med. 2024 Nov 22.

ObjectivesIntubation 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.DesignFactorial 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).SettingAnonymous web-based survey.SubjectsClinicians involved in the decision to intubate.InterventionsNone.Measurements And Main ResultsBetween 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.ConclusionsIn 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.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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