Robert S Green1, Michael B Butler, Mete Erdogan. 1. From the Department of Critical Care (R.S.G., M.B.B.), Dalhousie University, Halifax, NS, Canada; and Trauma Nova Scotia, Nova Scotia Department of Health and Wellness (R.S.G., M.E.), Halifax, NS, Canada.
Abstract
BACKGROUND: Postintubation hypotension (PIH) is common and associated with poor outcomes in critically ill patient populations requiring emergency endotracheal intubation (ETI). The importance of PIH in the trauma population remains unclear. The objective of this study was to determine the prevalence of PIH in trauma patients and assess the association of PIH with patient outcomes. METHODS: Retrospective case series of adult (≥16 years) patients who were intubated on arrival at a tertiary trauma center in Halifax, Nova Scotia, Canada, between 2000 and 2015. Data were collected from the Nova Scotia Trauma Registry and patient chart, and included demographics, comorbidities, trauma characteristics, intubation time, as well as all fluids, medications, adverse events, interventions, and vital signs during the 15 minutes before/after ETI. We evaluated the prevalence of PIH and created a logistic regression model to determine likelihood of mortality in the PIH and non-PIH groups after controlling for patient and provider characteristics. RESULTS: Overall, 477 patients required ETI on assessment by the trauma service, of which 444 patients met eligibility criteria and were included in the analysis. The prevalence of PIH was 36.3% (161 of 444) in our study population. In-hospital mortality occurred in 29.8% (48 of 161) of patients in the PIH group, compared with 15.9% (45 of 283) of patients in the non-PIH group (p = 0.001). Development of PIH was associated with increased mortality in the emergency department (adjusted odds ratio, 3.45; 95% confidence interval, 1.42-8.36) and in-hospital (adjusted odds ratio, 1.83; 95% confidence interval, 1.01-3.31). CONCLUSION: In our study of trauma patients requiring ETI, development of PIH was common (36.3%) and associated with increased mortality. Intubation practices in critically ill trauma patients is an important patient safety issue that requires further investigation. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III; Level IV, Therapeutic.
BACKGROUND: Postintubation hypotension (PIH) is common and associated with poor outcomes in critically ill patient populations requiring emergency endotracheal intubation (ETI). The importance of PIH in the trauma population remains unclear. The objective of this study was to determine the prevalence of PIH in traumapatients and assess the association of PIH with patient outcomes. METHODS: Retrospective case series of adult (≥16 years) patients who were intubated on arrival at a tertiary trauma center in Halifax, Nova Scotia, Canada, between 2000 and 2015. Data were collected from the Nova Scotia Trauma Registry and patient chart, and included demographics, comorbidities, trauma characteristics, intubation time, as well as all fluids, medications, adverse events, interventions, and vital signs during the 15 minutes before/after ETI. We evaluated the prevalence of PIH and created a logistic regression model to determine likelihood of mortality in the PIH and non-PIH groups after controlling for patient and provider characteristics. RESULTS: Overall, 477 patients required ETI on assessment by the trauma service, of which 444 patients met eligibility criteria and were included in the analysis. The prevalence of PIH was 36.3% (161 of 444) in our study population. In-hospital mortality occurred in 29.8% (48 of 161) of patients in the PIH group, compared with 15.9% (45 of 283) of patients in the non-PIH group (p = 0.001). Development of PIH was associated with increased mortality in the emergency department (adjusted odds ratio, 3.45; 95% confidence interval, 1.42-8.36) and in-hospital (adjusted odds ratio, 1.83; 95% confidence interval, 1.01-3.31). CONCLUSION: In our study of traumapatients requiring ETI, development of PIH was common (36.3%) and associated with increased mortality. Intubation practices in critically ill traumapatients is an important patient safety issue that requires further investigation. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III; Level IV, Therapeutic.
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: Urs Pietsch; Jürgen Knapp; Oliver Kreuzer; Ludwig Ney; Giacomo Strapazzon; Volker Lischke; Roland Albrecht; Patrick Phillips; Simon Rauch Journal: Scand J Trauma Resusc Emerg Med Date: 2018-04-03 Impact factor: 2.953