Marcel Émond1,2,3,4, David Lachance-Perreault5, Valérie Boucher6,7,8, Pierre-Hugues Carmichael8, Jeanne Turgeon5, Audrey-Anne Brousseau9, Alexandra Akoum5, Jean-Nicolas Tourigny6,7,5, Natalie Le Sage6,7,5. 1. CHU de Québec-Université Laval Research Centre, 18e rue, 1401, H-608, Quebec, QC, G1J 1Z4, Canada. marcelemond1@me.com. 2. VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, QC, Canada. marcelemond1@me.com. 3. Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada. marcelemond1@me.com. 4. Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, QC, Canada. marcelemond1@me.com. 5. Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada. 6. CHU de Québec-Université Laval Research Centre, 18e rue, 1401, H-608, Quebec, QC, G1J 1Z4, Canada. 7. VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, QC, Canada. 8. Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, QC, Canada. 9. Département de médecine familiale et médecine d'urgence, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Abstract
OBJECTIVE: To evaluate the association between standard post-intubation hypotension (< 90 mmHg) and in-hospital mortality. Secondary objectives were to evaluate the association of post-intubation hypotension and length of stay and to assess the impact of increasing post-intubation hypotension threshold to 110 mmHg on hospital length of stay and 48 h-mortality in patients aged ≥ 65 years. METHODS: Design and setting: A cohort of patients admitted in a level-1 trauma centre emergency department (ED) between November 2011 and July 2016. INCLUSION CRITERIA: aged ≥ 16 with available pre-intubation vital signs, intubation performed in ≤ 3 attempts with no surgical access needed. MEASURES: Prospective electronic data collection was used for clinical data. MAIN OUTCOME: 48-h in-hospital mortality. SECONDARY OUTCOME: hospital length of stay. ANALYSES: Univariate and multivariate analyses. RESULTS: A total of 586 patients were included. The mean age was 56.3 ± 18.8 years and 37% were aged ≥ 65 years. Within 60 min of intubation, 224 (38%) patients had at least one systolic blood pressure measure < 90 mmHg and 164(28%) had at least two measures. The < 110 mmHg threshold showed a total of 377 patients (64%) had at least one systolic blood pressure measure < 110 mmHg and 286 (49%) had at least two measures. We found no significant difference in the risk of mortality overall and in stratified-age groups and no association with increased hospital length of stay using both post-intubation hypotension thresholds. CONCLUSION: Post-intubation hypotension was recorded in one out of three patients in the ED but we found no association between post-intubation hypotension and 48-h in-hospital mortality overall in adults or geriatric patients.
OBJECTIVE: To evaluate the association between standard post-intubation hypotension (< 90 mmHg) and in-hospital mortality. Secondary objectives were to evaluate the association of post-intubation hypotension and length of stay and to assess the impact of increasing post-intubation hypotension threshold to 110 mmHg on hospital length of stay and 48 h-mortality in patients aged ≥ 65 years. METHODS: Design and setting: A cohort of patients admitted in a level-1 trauma centre emergency department (ED) between November 2011 and July 2016. INCLUSION CRITERIA: aged ≥ 16 with available pre-intubation vital signs, intubation performed in ≤ 3 attempts with no surgical access needed. MEASURES: Prospective electronic data collection was used for clinical data. MAIN OUTCOME: 48-h in-hospital mortality. SECONDARY OUTCOME: hospital length of stay. ANALYSES: Univariate and multivariate analyses. RESULTS: A total of 586 patients were included. The mean age was 56.3 ± 18.8 years and 37% were aged ≥ 65 years. Within 60 min of intubation, 224 (38%) patients had at least one systolic blood pressure measure < 90 mmHg and 164(28%) had at least two measures. The < 110 mmHg threshold showed a total of 377 patients (64%) had at least one systolic blood pressure measure < 110 mmHg and 286 (49%) had at least two measures. We found no significant difference in the risk of mortality overall and in stratified-age groups and no association with increased hospital length of stay using both post-intubation hypotension thresholds. CONCLUSION: Post-intubation hypotension was recorded in one out of three patients in the ED but we found no association between post-intubation hypotension and 48-h in-hospital mortality overall in adults or geriatric patients.
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