Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes

Sangita Trivedi, Onur Demirci, Grace Arteaga, Rahul Kashyap, Nathan Smischney

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

PURPOSE: Preintubation shock index (SI) and modified shock index (MSI) have demonstrated predictive capability for postintubation hypotension in emergency department. The primary aim was to explore this relationship in the critical care environment. The secondary aims were to evaluate the relationship of shock indices with other short-term outcomes like mortality and length of stay in intensive care unit.

MATERIALS AND METHODS: This is a nonconcurrent cohort study, conducted in eligible 140 adult intensive care unit (ICU) patients of a tertiary care medical center. Eligibility criterion was emergent endotracheal intubation in apparently hemodynamically stable patients.

RESULTS: Preintubation SI ≥ 0.90 had a significant association with postintubation hypotension as defined by systolic blood pressure < 90 mm Hg in the univariate (P = .03; odds ratio [OR], 2.13; 95% confidence interval [CI], 1.07-4.35) and multivariate analyses (P = .01; OR, 3.17; 95% CI, 1.36-7.73) after adjusting for confounders. It was also associated with higher ICU mortality in both the univariate (P = .01; OR, 4.00; 95% CI, 1.26-12.67) and multivariate analyses (P = .01; OR, 5.75; 95% CI, 1.58-26.48). There was no association of preintubation MSI with postintubation hemodynamic instability and ICU mortality. No association was found between preintubation SI and MSI, with ICU length of stay and 30-day mortality.

CONCLUSIONS: Our findings indicate that preintubation SI greater than or equal to 0.90 is a predictor of postintubation hypotension (systolic blood pressure <90 mm Hg) and ICU mortality in emergently intubated adult patients in intensive care units.

Original languageEnglish (US)
JournalJournal of Critical Care
Volume30
Issue number4
DOIs
StatePublished - Aug 1 2015

Fingerprint

Hypotension
Shock
Intensive Care Units
Odds Ratio
Mortality
Confidence Intervals
Blood Pressure
Length of Stay
Multivariate Analysis
Intratracheal Intubation
Critical Care
Tertiary Care Centers
Hospital Emergency Service
Cohort Studies
Hemodynamics

Keywords

  • Emergent intubation
  • Hemodynamic instability
  • Mortality
  • Postintubation hypotension
  • Preintubation modified shock index
  • Preintubation shock index

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes. / Trivedi, Sangita; Demirci, Onur; Arteaga, Grace; Kashyap, Rahul; Smischney, Nathan.

In: Journal of Critical Care, Vol. 30, No. 4, 01.08.2015.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: Preintubation shock index (SI) and modified shock index (MSI) have demonstrated predictive capability for postintubation hypotension in emergency department. The primary aim was to explore this relationship in the critical care environment. The secondary aims were to evaluate the relationship of shock indices with other short-term outcomes like mortality and length of stay in intensive care unit.MATERIALS AND METHODS: This is a nonconcurrent cohort study, conducted in eligible 140 adult intensive care unit (ICU) patients of a tertiary care medical center. Eligibility criterion was emergent endotracheal intubation in apparently hemodynamically stable patients.RESULTS: Preintubation SI ≥ 0.90 had a significant association with postintubation hypotension as defined by systolic blood pressure < 90 mm Hg in the univariate (P = .03; odds ratio [OR], 2.13; 95{\%} confidence interval [CI], 1.07-4.35) and multivariate analyses (P = .01; OR, 3.17; 95{\%} CI, 1.36-7.73) after adjusting for confounders. It was also associated with higher ICU mortality in both the univariate (P = .01; OR, 4.00; 95{\%} CI, 1.26-12.67) and multivariate analyses (P = .01; OR, 5.75; 95{\%} CI, 1.58-26.48). There was no association of preintubation MSI with postintubation hemodynamic instability and ICU mortality. No association was found between preintubation SI and MSI, with ICU length of stay and 30-day mortality.CONCLUSIONS: Our findings indicate that preintubation SI greater than or equal to 0.90 is a predictor of postintubation hypotension (systolic blood pressure <90 mm Hg) and ICU mortality in emergently intubated adult patients in intensive care units.",
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AU - Kashyap, Rahul

AU - Smischney, Nathan

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N2 - PURPOSE: Preintubation shock index (SI) and modified shock index (MSI) have demonstrated predictive capability for postintubation hypotension in emergency department. The primary aim was to explore this relationship in the critical care environment. The secondary aims were to evaluate the relationship of shock indices with other short-term outcomes like mortality and length of stay in intensive care unit.MATERIALS AND METHODS: This is a nonconcurrent cohort study, conducted in eligible 140 adult intensive care unit (ICU) patients of a tertiary care medical center. Eligibility criterion was emergent endotracheal intubation in apparently hemodynamically stable patients.RESULTS: Preintubation SI ≥ 0.90 had a significant association with postintubation hypotension as defined by systolic blood pressure < 90 mm Hg in the univariate (P = .03; odds ratio [OR], 2.13; 95% confidence interval [CI], 1.07-4.35) and multivariate analyses (P = .01; OR, 3.17; 95% CI, 1.36-7.73) after adjusting for confounders. It was also associated with higher ICU mortality in both the univariate (P = .01; OR, 4.00; 95% CI, 1.26-12.67) and multivariate analyses (P = .01; OR, 5.75; 95% CI, 1.58-26.48). There was no association of preintubation MSI with postintubation hemodynamic instability and ICU mortality. No association was found between preintubation SI and MSI, with ICU length of stay and 30-day mortality.CONCLUSIONS: Our findings indicate that preintubation SI greater than or equal to 0.90 is a predictor of postintubation hypotension (systolic blood pressure <90 mm Hg) and ICU mortality in emergently intubated adult patients in intensive care units.

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KW - Preintubation modified shock index

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