A Retrospective Review of Tracheal Intubation of Obstetrical Patients, Incidence and Associated Factors.

Abstract

Tracheal intubation (TI) of an obstetrical patient around the time of delivery can be an upsetting event for involved providers. It can also cause an unpredictable use of intensive care resources. Its incidence is currently poorly characterized in the literature. We analyzed the 2019 National Inpatient Sample (NIS) to assess the incidence rate and associated risk factors. Patients were identified by International Classification of Diseases, 10th edition codes for delivery of a child. Measured endpoints were the incidence of TI and factors associated. Categorical variables were compared using Chi squared or Fisher's Exact. Continuous variables were compared using the Student T-test or the Mann Whitney rank sum U-test. A logistic regression model was created to determine the odds for each variable contributing to TI. A P value of 0.05 was considered the minimum standard for significance. There was a low rate of TI (0.03%). Mortality was rare (0.004%) and there was a higher rate of mortality among patients who underwent tracheal intubation (5.5% vs 0.003% among patients not intubated,  < .001). The majority of intubations occurred among patients who delivered via CD. Pneumonia, cardiomyopathy, eclampsia, and postpartum hemorrhage were all independently associated with increased odds for TI. There are risk factors which may increase the likelihood for tracheal intubation. The diagnosis of a cardiomyopathy was strongly associated with an increased odds for TI and may result from acute respiratory failure. PPH and eclampsia were also associated with a greater odds for intubation.