Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill

• Published in: Medical science monitor Vol. 22; pp. 346 - 355
• Main Authors: Smischney, Nathan J, Demirci, Onur, Diedrich, Daniel A, Barbara, David W, Sandefur, Benjamin J, Trivedi, Sangita, McGarry, Sean, Kashyap, Rahul
• Format: Journal Article
• Language: English
• Published: United States International Scientific Literature, Inc 02-02-2016
• Subjects: Clinical Research; Critical Illness - epidemiology; Female; Hemodynamics; Hospital Mortality; Humans; Hypotension - epidemiology; Hypotension - etiology; Hypotension - physiopathology; Incidence; Intubation, Intratracheal - adverse effects; Length of Stay; Male; Middle Aged; Multivariate Analysis; Risk Factors; Severity of Illness Index
• ISSN: 1643-3750; 1234-1010; 1643-3750
• DOI: 10.12659/MSM.895919

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.
Adult (≥18 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.
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).
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.