Incidence and Risk Factors for Adverse Events During Intubation among Critically Ill Patients in Nigeria.

Abstract

Background: Owing to the background physiologic derangements in critically ill patients, the risk of peri-intubation adverse events is higher than is seen in the operating room. Despite the burden of the problem, very little local data exists in Nigeria and sub-Saharan Africa. The objective of this study was to determine the incidence and risk factors for peri-intubation adverse events in the intensive care unit (ICU).

Methodology: This was a prospective, observational, multi-centre study involving critically ill adults requiring endotracheal intubation in the ICU between February and September 2024. The primary outcome measure was the incidence of peri-intubation adverse events (hypotension, hypoxia, cardiac arrest, and aspiration of gastric content) within 30 minutes of intubation. The secondary outcome measures included risk factors for these adverse events and their correlation with the length of ICU stay and 30-day in-hospital mortality. Data were analysed using SPSS version 25.

Results: Fifty-one intubations involving 50 patients were included. Respiratory failure and neurological impairment were the major reasons for intubation (49.0% and 35.3%, respectively). The incidences of adverse events were hypotension (60%), severe hypoxia (32.6%), cardiac arrest (13.7%) and aspiration pneumonitis (17.8%). At least one adverse event was recorded in 74.8% of the intubations. We identified multiple intubation attempts as central to the occurrence of most adverse events. The probability of survival was higher in those with an adverse event, but it was not statistically significant.

Conclusion: Adverse events following intubation are common among critically ill patients in Nigeria. While hypotension was the most common complication, severe hypoxaemia emerged as the most lethal. Further research is needed on this subject.