Nathan J Smischney1, Mohamed O Seisa2, Katherine J Heise3, Robert A Wiegand4, Kyle D Busack5, Jillian L Deangelis6, Theodore O Loftsgard7, Darrell R Schroeder8, Daniel A Diedrich9. 1. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: smischney.nathan@mayo.edu. 2. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: seisa.mohamed@mayo.edu. 3. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: heise.katherine@mayo.edu. 4. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: wiegand.robert@mayo.edu. 5. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: busack.kyle@mayo.edu. 6. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: Deangelis.jillian@mayo.edu. 7. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: loftsgard.theodore@mayo.edu. 8. Department of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: schroeder.darrell@mayo.edu. 9. Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: diedrich.daniel@mayo.edu.
Abstract
PURPOSE: Our primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period. METHODS: We conducted a nested case-control study of a previously identified cohort of adult patients needing intubation admitted to a medical-surgical ICU during 2013-2014. Hemodynamic derangement was defined as cardiac arrest and/or the development of systolic blood pressure <90mmHg and/or mean arterial pressure <65mmHg 30min following intubation. Data during the peri-intubation period was analyzed. RESULTS: The final cohort included 420 patients. Immediate hemodynamic derangement occurred in 170 (40%) patients. On multivariate modeling, age/10year increase (OR 1.20, 95% CI 1.03-1.39, p=0.02), pre-intubation non-invasive ventilation (OR 1.71, 95% CI 1.04-2.80, p=0.03), pre-intubation shock index/1 unit (OR 5.37 95% CI 2.31-12.46, p≤0.01), and pre-intubation modified shock index/1 unit (OR 2.73 95% CI 1.48-5.06, p≤0.01) were significantly associated with hemodynamic derangement. Those experiencing hemodynamic derangement had higher ICU [47 (28%) vs. 33 (13%); p≤0.001] and hospital [69 (41%) vs. 51 (20%); p≤0.001] mortality. CONCLUSIONS: Hemodynamic derangement occurred at a rate of 40% and was associated with increased mortality. Increasing age, use of non-invasive ventilation before intubation, and increased pre-intubation shock and modified shock index values were significantly associated with hemodynamic derangement post-intubation.
PURPOSE: Our primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period. METHODS: We conducted a nested case-control study of a previously identified cohort of adult patients needing intubation admitted to a medical-surgical ICU during 2013-2014. Hemodynamic derangement was defined as cardiac arrest and/or the development of systolic blood pressure <90mmHg and/or mean arterial pressure <65mmHg 30min following intubation. Data during the peri-intubation period was analyzed. RESULTS: The final cohort included 420 patients. Immediate hemodynamic derangement occurred in 170 (40%) patients. On multivariate modeling, age/10year increase (OR 1.20, 95% CI 1.03-1.39, p=0.02), pre-intubation non-invasive ventilation (OR 1.71, 95% CI 1.04-2.80, p=0.03), pre-intubation shock index/1 unit (OR 5.37 95% CI 2.31-12.46, p≤0.01), and pre-intubation modified shock index/1 unit (OR 2.73 95% CI 1.48-5.06, p≤0.01) were significantly associated with hemodynamic derangement. Those experiencing hemodynamic derangement had higher ICU [47 (28%) vs. 33 (13%); p≤0.001] and hospital [69 (41%) vs. 51 (20%); p≤0.001] mortality. CONCLUSIONS: Hemodynamic derangement occurred at a rate of 40% and was associated with increased mortality. Increasing age, use of non-invasive ventilation before intubation, and increased pre-intubation shock and modified shock index values were significantly associated with hemodynamic derangement post-intubation.
Authors: Nathan J Smischney; Mohamed O Seisa; Allison S Morrow; Oscar J Ponce; Zhen Wang; Muayad Alzuabi; Katherine J Heise; Mohammad H Murad Journal: Anesthesiol Res Pract Date: 2020-05-08
Authors: Bişar Ergün; Begüm Ergan; Mehmet Nuri Yakar; Murat Küçük; Murat Özçelik; Erdem Yaka; Ali Necati Gökmen Journal: Rev Bras Ter Intensiva Date: 2022 Jan-Mar