Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management—Part II

Nathan Smischney, Mohamed O. Seisa, Katherine J. Heise, Robert A. Wiegand, Kyle D. Busack, Jillian L. Deangelis, Theodore O. Loftsgard, Darrell R. Schroeder, Daniel A. Diedrich

Research output: Contribution to journalArticle

7 Scopus citations

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 < 90 mm Hg and/or mean arterial pressure < 65 mm Hg 30 min 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/10 year 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.

Original languageEnglish (US)
Pages (from-to)179-184
Number of pages6
JournalJournal of Critical Care
Volume44
DOIs
StatePublished - Apr 1 2018

Keywords

  • Critically ill
  • Hemodynamic management
  • Hypotension
  • Intensive care unit
  • Intubation
  • Nested case-control study

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Smischney, N., Seisa, M. O., Heise, K. J., Wiegand, R. A., Busack, K. D., Deangelis, J. L., Loftsgard, T. O., Schroeder, D. R., & Diedrich, D. A. (2018). Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management—Part II. Journal of Critical Care, 44, 179-184. https://doi.org/10.1016/j.jcrc.2017.10.018