OBJECTIVES: Postintubation hemodynamic instability (PIHI) is a potentially life-threatening adverse event of emergent endotracheal intubation. The objectives of this study were to determine the incidence, risk factors, and impact on patient outcomes associated with PIHI in intubations performed in emergency medicine. METHODS: A structured chart audit was performed of all consecutive adult patients requiring emergent endotracheal intubations over a 16-month period at a tertiary care emergency department (ED). Data collection included medications, comorbidities, vital signs in the 30 minutes before and after intubation, hospital length of stay, and in-hospital mortality. PIHI was defined as a decrease in systolic blood pressure (SBP) to ≤ 90 mm Hg, a decrease in SBP of ≥ 20% from baseline, a decrease in mean arterial pressure to ≤ 65 mm Hg, or the initiation of any vasopressor medication at any time in the 30 minutes following intubation. RESULTS: Overall, 218 patients intubated in the ED were identified, and 44% (96 of 218) developed PIHI. On multivariate analysis, increasing age (OR 1.03, 95% CI 1.01-1.05), chronic obstructive pulmonary disease (OR 3.00, CI 1.19-7.57), and pre-emergent endotracheal intubation hemodynamic instability (OR 2.52, 95% CI 1.27-4.99) were associated with the development of PIHI. The use of a neuromuscular blocking medication was associated with a decreased incidence of PIHI (OR 0.34, 95% CI 0.16-0.75). CONCLUSIONS: Based on our data, postintubation hypotension occurs in a significant proportion of ED patients requiring emergent airway control. Further investigation is needed to confirm the factors we found to be associated with PIHI and to determine if PIHI is associated with increased morbidity and mortality.
OBJECTIVES: Postintubation hemodynamic instability (PIHI) is a potentially life-threatening adverse event of emergent endotracheal intubation. The objectives of this study were to determine the incidence, risk factors, and impact on patient outcomes associated with PIHI in intubations performed in emergency medicine. METHODS: A structured chart audit was performed of all consecutive adult patients requiring emergent endotracheal intubations over a 16-month period at a tertiary care emergency department (ED). Data collection included medications, comorbidities, vital signs in the 30 minutes before and after intubation, hospital length of stay, and in-hospital mortality. PIHI was defined as a decrease in systolic blood pressure (SBP) to ≤ 90 mm Hg, a decrease in SBP of ≥ 20% from baseline, a decrease in mean arterial pressure to ≤ 65 mm Hg, or the initiation of any vasopressor medication at any time in the 30 minutes following intubation. RESULTS: Overall, 218 patients intubated in the ED were identified, and 44% (96 of 218) developed PIHI. On multivariate analysis, increasing age (OR 1.03, 95% CI 1.01-1.05), chronic obstructive pulmonary disease (OR 3.00, CI 1.19-7.57), and pre-emergent endotracheal intubation hemodynamic instability (OR 2.52, 95% CI 1.27-4.99) were associated with the development of PIHI. The use of a neuromuscular blocking medication was associated with a decreased incidence of PIHI (OR 0.34, 95% CI 0.16-0.75). CONCLUSIONS: Based on our data, postintubation hypotension occurs in a significant proportion of ED patients requiring emergent airway control. Further investigation is needed to confirm the factors we found to be associated with PIHI and to determine if PIHI is associated with increased morbidity and mortality.
Authors: Ramiro Manzano-Nunez; Juan Pablo Herrera-Escobar; Joseph DuBose; Tal Hörer; Samuel Galvagno; Claudia Patricia Orlas; Michael W Parra; Federico Coccolini; Massimo Sartelli; Juan Camilo Falla-Martinez; Alberto Federico García; Julian Chica; Maria Paula Naranjo; Alvaro Ignacio Sanchez; Camilo Jose Salazar; Luis Eduardo Calderón-Tapia; Valeria Lopez-Castilla; Paula Ferrada; Ernest E Moore; Carlos A Ordonez Journal: Eur J Trauma Emerg Surg Date: 2018-03-23 Impact factor: 3.693
Authors: Nathan J Smischney; Onur Demirci; Bryce D Ricter; Christina C Hoeft; Lisa M Johnson; Shejan Ansar; Rahul Kashyap Journal: BMC Res Notes Date: 2015-09-15
Authors: Nathan J Smischney; Onur Demirci; Daniel A Diedrich; David W Barbara; Benjamin J Sandefur; Sangita Trivedi; Sean McGarry; Rahul Kashyap Journal: Med Sci Monit Date: 2016-02-02
Authors: Robert S Green; Dean A Fergusson; Alexis F Turgeon; Lauralyn A McIntyre; George J Kovacs; Donald E Griesdale; Ryan Zarychanski; Michael B Butler; Nelofar Kureshi; Mete Erdogan Journal: West J Emerg Med Date: 2016-07-26