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02 February 2016 : Clinical Research  

Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill

Nathan J. SmischneyABCDEF, Onur DemirciABDEF, Daniel A. DiedrichBDEF, David W. BarbaraBDEF, Benjamin J. SandefurBDEF, Sangita TrivediABDEF, Sean McGarryBDEF, Rahul KashyapABCDE

DOI: 10.12659/MSM.895919

Med Sci Monit 2016; 22:346-355

Abstract

BACKGROUND: We aim to report the incidence of post-intubation hypotension in the critically ill, to report in-hospital mortality and length of stay in those who developed post-intubation hypotension, and to explore possible risk factors associated with post-intubation hypotension.

MATERIAL AND METHODS: Adult (≥18 years) ICU patients who received emergent endotracheal intubation were included. We excluded patients if they were hemodynamically unstable 60 minutes pre-intubation. Post-intubation hypotension was defined as the administration of any vasopressor within 60 minutes following intubation.

RESULTS: Twenty-nine patients developed post-intubation hypotension (29/147, 20%). Post-intubation hypotension was associated with increased in-hospital mortality (11/29, 38% vs. 19/118, 16%) and length of stay (21 [10–37] vs. 12 [7–21] days) on multivariate analysis. Three risk factors for post-intubation hypotension were identified on multivariate analysis: 1) decreasing mean arterial pressure pre-intubation (per 5 mmHg decrease) (p-value=0.04; 95% CI 1.01–1.55); 2) administration of neuromuscular blockers (p-value=0.03; 95% CI 1.12–6.53); and 3) intubation complication (p-value=0.03; 95% CI 1.16–15.57).

CONCLUSIONS: Post-intubation hypotension was common in the ICU and was associated with increased in-hospital mortality and length of stay. These patients were more likely to have had lower mean arterial pressure prior to intubation, received neuromuscular blockers, or suffered a complication during intubation.

Keywords: Hemodynamics, Critical Illness - epidemiology, Hospital Mortality, Hypotension - physiopathology, Incidence, Intubation, Intratracheal - adverse effects, Length of Stay, Multivariate Analysis, Risk Factors, Severity of Illness Index

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750