Robert S Green1, Alexis F Turgeon2, Lauralyn A McIntyre3, Alison E Fox-Robichaud4, Dean A Fergusson5, Steve Doucette6, Michael B Butler7, Mete Erdogan8. 1. Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Trauma Nova Scotia, Halifax, Nova Scotia, Canada. Electronic address: greenrs@dal.ca. 2. CHU de Québec Research Center, Hôpital de L'Enfant-Jésus, Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine Group), Université Laval, Québec City, Québec, Canada; Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada. Electronic address: alexis.turgeon@fmed.ulaval.ca. 3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: lmcintyre@ohri.ca. 4. Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, David Braley Research Institute, Hamilton, Ontario, Canada. Electronic address: afoxrob@mcmaster.ca. 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: dafergusson@ohri.ca. 6. Department of Community Health and Epidemiology (Capital Health, Dalhousie University, IWK Health Centre), Centre for Clinical Research, Halifax, Nova Scotia, Canada. Electronic address: Steve.Doucette@nshealth.ca. 7. Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: mbbutler@dal.ca. 8. Trauma Nova Scotia, Halifax, Nova Scotia, Canada. Electronic address: mete.erdogan@nshealth.ca.
Abstract
PURPOSE: To determine the incidence of postintubation hypotension (PIH) and associated outcomes in critically ill patients requiring endotracheal intubation. MATERIALS AND METHODS: Medical records were reviewed for 479 consecutive critically ill adult patients who required intubation by an intensive care unit (ICU) service at 1 of 4 academic tertiary care hospitals. The primary outcome measure was the incidence of PIH. Secondary outcome measures included mortality, ICU length of stay, requirement for renal replacement therapy, and a composite end point consisting of overall mortality, ICU length of stay greater than 14 days, duration of mechanical ventilation longer than 7 days, and renal replacement therapy requirement. RESULTS: Overall, the incidence of PIH among ICU patients requiring intubation was 46% (218/479 patients). On univariate analysis, patients who developed PIH had increased ICU mortality (37% PIH vs 28% no PIH, P = .049) and overall mortality (39% PIH vs 30% no PIH, P = .045). After adjusting for important risk factors, development of PIH was associated with the composite end point of major morbidity and mortality (odds ratio, 2.00; 95% confidence interval, 1.30-3.07; P = .0017). CONCLUSIONS: The development of PIH is common in ICU patients requiring emergency airway control and is associated with poor patient outcomes.
PURPOSE: To determine the incidence of postintubation hypotension (PIH) and associated outcomes in critically illpatients requiring endotracheal intubation. MATERIALS AND METHODS: Medical records were reviewed for 479 consecutive critically ill adult patients who required intubation by an intensive care unit (ICU) service at 1 of 4 academic tertiary care hospitals. The primary outcome measure was the incidence of PIH. Secondary outcome measures included mortality, ICU length of stay, requirement for renal replacement therapy, and a composite end point consisting of overall mortality, ICU length of stay greater than 14 days, duration of mechanical ventilation longer than 7 days, and renal replacement therapy requirement. RESULTS: Overall, the incidence of PIH among ICU patients requiring intubation was 46% (218/479 patients). On univariate analysis, patients who developed PIH had increased ICU mortality (37% PIH vs 28% no PIH, P = .049) and overall mortality (39% PIH vs 30% no PIH, P = .045). After adjusting for important risk factors, development of PIH was associated with the composite end point of major morbidity and mortality (odds ratio, 2.00; 95% confidence interval, 1.30-3.07; P = .0017). CONCLUSIONS: The development of PIH is common in ICU patients requiring emergency airway control and is associated with poor patient outcomes.
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