Outcomes in randomized trials of tracheal intubation in the critically ill: A systematic review
- Journal
- The American journal of emergency medicine (Q1)
- Published
- 23 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Takatoshi Koroki, Yuki Kotani, Tomohisa Nagayama, Taisuke Shibata, Koya Akutagawa, Motoki Fujii, et al.
- PMID
- 42527163
- DOI
- 10.1016/j.ajem.2026.07.030
Why clinicians should know about it
- Picked for Physiology (medical) (top studies of the week, 2 August 2026).
Abstract
BACKGROUND: Critically ill patients undergoing tracheal intubation experience a high rate of peri-intubation adverse events. The lack of consensus on outcome selection hinders comparisons across studies. Therefore, we conducted this review to systematically identify outcome measures reported in randomized controlled trials investigating tracheal intubation in critically ill adults. METHODS: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception through July 5, 2025, for randomized controlled trials published in high-impact journals enrolling critically ill adults undergoing tracheal intubation. We described primary and secondary outcomes, categorized them into four domains (clinical, physiological, procedural, and other), and documented associations between interventions and primary outcomes. RESULTS: We identified 43 randomized controlled trials, with 15 primary and 46 secondary outcomes. Hypoxemia was the most frequently reported primary outcome (12 studies, 28%), followed by first-pass success (11 studies, 26%), cardiovascular instability/collapse (3 studies, 6.9%). Common secondary outcomes were hypoxemia (26 studies, 60%) and mortality (21 studies, 49%), followed by intubation difficulty (20/43, 47%), cardiovascular instability/collapse (17/43, 40%), and the use and duration of organ support (16/43, 37%). Hypoxemia was the most common outcome in studies testing preoxygenation techniques (10 of 43, 23%), whereas first-pass success was predominant in those assessing laryngoscope types (7 of 43, 16%). CONCLUSIONS: Tracheal intubation trials have predominantly prioritized short-term physiological stability and procedural success, with minimal attention to patient-centered recovery outcomes. Adoption of a core outcome set is essential. CLINICAL TRIALS REGISTRATION: International Prospective Register of Systematic Reviews (CRD420251081056).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.