Incidence of and risk factors for post-intubation hypotension in the critically Ill

Nathan J. Smischney, Onur Demirci, Daniel A. Diedrich, David W. Barbara, Benjamin J. Sandefur, Sangita Trivedi, Sean McGarry, Rahul Kashyap

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Background: We aim to report the incidence of post-intubation hypotension in the critically ill, to report in-hospital mortality and length of stay in those who developed post-intubation hypotension, and to explore possible risk factors associated with post-intubation hypotension. Material/Methods: Adult (³18 years) ICU patients who received emergent endotracheal intubation were included. We excluded patients if they were hemodynamically unstable 60 minutes pre-intubation. Post-intubation hypotension was defined as the administration of any vasopressor within 60 minutes following intubation. Results: Twenty-nine patients developed post-intubation hypotension (29/147, 20%). Post-intubation hypotension was associated with increased in-hospital mortality (11/29, 38% vs. 19/118, 16%) and length of stay (21 [10–37] vs. 12 [7–21] days) on multivariate analysis. Three risk factors for post-intubation hypotension were identified on multivariate analysis: 1) decreasing mean arterial pressure pre-intubation (per 5 mmHg decrease) (p-value= 0.04; 95% CI 1.01–1.55); 2) administration of neuromuscular blockers (p-value=0.03; 95% CI 1.12–6.53); and 3) intubation complication (p-value=0.03; 95% CI 1.16–15.57). Conclusions: Post-intubation hypotension was common in the ICU and was associated with increased in-hospital mortality and length of stay. These patients were more likely to have had lower mean arterial pressure prior to intubation, received neuromuscular blockers, or suffered a complication during intubation.

Original languageEnglish (US)
Pages (from-to)346-355
Number of pages10
JournalMedical Science Monitor
Volume22
DOIs
StatePublished - Feb 2 2016

Keywords

  • Hemodynamics
  • Hospital mortality
  • Intensive care
  • Intubation
  • Length of stay
  • Risk factors

ASJC Scopus subject areas

  • Medicine(all)

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