Quiz Ref ID Tracheal intubation is a high-risk procedure commonly performed in critically ill patients, yet relatively little is known about adverse peri-intubation events.¹ Underlying shock, respiratory failure, metabolic acidosis, and other pathophysiological changes substantially increase the risk of adverse peri-intubation events in critically ill patients compared with patients undergoing intubation in the operating room.^1-6 Small prospective studies, retrospective analyses, or national level studies^7-9 suggest that up to 28% of critically ill patients undergoing tracheal intubation may experience a life-threatening complication such as severe hypoxemia or hemodynamic instability and 2.7% of procedures are complicated by cardiac arrest.^7,10 In 2011, the Fourth National Audit Project launched in the UK was the first attempt to assess intubation-related morbidity and mortality at a national level.⁹ It reported major gaps in clinical practice such as poor identification of at-risk patients, poor planning, unavailability of skilled clinicians and equipment especially during off hours, and lack of—or failure to correctly interpret—capnography. In addition, the current incidence and consequences of adverse peri-intubation events on either short-term or long-term patient survival have never been investigated before in a large international prospective cohort. Systematic evaluation of routine clinical practice and occurrence of adverse events could establish the baseline for investigating higher-priority interventions to reduce this risk.

Rationale: Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital’s sepsis plan. Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. Conclusions: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.

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