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Evaluation of the incidence, risk factors, and impact on patient outcomes of postintubation hemodynamic instability

Published online by Cambridge University Press:  11 May 2015

Robert S. Green ,
Janet Edwards ,
Elham Sabri  and
Dean Fergusson
Robert S. Green*
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS Division of Critical Care Medicine, Department of Anesthesia, Dalhousie University, Halifax, NS Ottawa Center for Transfusion Research, Ottawa, ON
Janet Edwards
Affiliation:
Department of Surgery, University of Calgary, Calgary, AB
Elham Sabri
Affiliation:
Ottawa Center for Transfusion Research, Ottawa, ON Ottawa Health Research Institute, Ottawa, ON
Dean Fergusson
Affiliation:
Ottawa Center for Transfusion Research, Ottawa, ON Ottawa Health Research Institute, Ottawa, ON
*
Room 377 Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9

Abstract

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Objective:

Postintubation hemodynamic instability (PIHI) is a potentially life-threatening adverse event of emergent endotracheal intubation. The objectives of this study were to determine the incidence, risk factors, and impact on patient outcomes associated with PIHI in intubations performed in emergency medicine.

Methods:

A structured chart audit was performed of all consecutive adult patients requiring emergent endotracheal intubations over a 16-month period at a tertiary care emergency department (ED). Data collection included medications, comorbidities, vital signs in the 30 minutes before and after intubation, hospital length of stay, and in-hospital mortality. PIHI was defined as a decrease in systolic blood pressure (SBP) to ≤ 90 mm Hg, a decrease in SBP of ≥ 20% from baseline, a decrease in mean arterial pressure to ≥ 65 mm Hg, or the initiation of any vasopressor medication at any time in the 30 minutes following intubation.

Results:

Overall, 218 patients intubated in the ED were identified, and 44% (96 of 218) developed PIHI. On multivariate analysis, increasing age (OR 1.03, 95% CI 1.01–1.05), chronic obstructive pulmonary disease (OR 3.00, CI 1.19–7.57), and pre–emergent endotracheal intubation hemodynamic instability (OR 2.52, 95% CI 1.27–4.99) were associated with the development of PIHI. The use of a neuromuscular blocking medication was associated with a decreased incidence of PIHI (OR 0.34, 95% CI 0.16–0.75).

Conclusions:

Based on our data, postintubation hypotension occurs in a significant proportion of ED patients requiring emergent airway control. Further investigation is needed to confirm the factors we found to be associated with PIHI and to determine if PIHI is associated with increased morbidity and mortality.

Keywords

adverse eventsairwayepidemiologyhypotensionintubation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 2 , March 2012 , pp. 74 - 82
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

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