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Cited by 69Airway Management and Intubation TechniquesRespiratory Support and MechanismsRestraint-Related Deaths

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

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Green, Robert S., Edwards, Janet, Sabri, Elham, Fergusson, Dean·2012·CJEM
DOI 10.2310/8000.2012.110548
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Abstract

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.

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  • The incidence of post intubation hypotension is high in patients requiring emergency airway management (23%-46%).

    “The incidence of post intubation hypotension is high in patients requiring emergency airway management (23%-46%)”

    From Airway Management in Trauma (2018) · cites this paper as [92]

    The Results (Abstract) report postintubation hemodynamic instability in 44% of 218 emergency-department patients, supporting the claim that it is common. The paper does not report a 23%–46% incidence range; its Discussion gives 0%–38.6% for previous studies. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Even transient drops in blood pressure are associated with adverse outcomes in trauma patients.

    “even transient drops in blood pressure are associated with adverse outcomes in trauma patients.23,[92][93][94]”

    From Airway Management in Trauma (2018) · cites this paper as [92]

    The Results report higher unadjusted mortality among ED patients with postintubation hypotension, and Table 6 reports deaths among patients with transient hypotension. But the paper does not establish an adverse-outcome association specifically for transient drops in trauma patients; its discussion says the overall mortality association was not present after adjustment and identifies sustained hypotension as associated with increased mortality. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Green, R. S., Edwards, J., Sabri, E., & Fergusson, D.
Affiliations
  • Dalhousie University (CA)
  • University of Calgary (CA)
Corresponding author
Green, Robert S.
ORCID
Venue
CJEM
Publisher
Springer Science and Business Media LLC
Published
2012-03
Volume
14
Issue
02
Pages
74-82
ISSN
  • 1481-8035 (ISSN-L)
  • 1481-8043
DOI
10.2310/8000.2012.110548
OpenAlex
W2139776082
Cited by
69
References
0
Citations by year
2026: 5 · 2025: 4 · 2024: 2 · 2023: 7 · 2022: 2 · 2021: 8 · 2020: 4 · 2019: 4 · 2018: 7 · 2017: 8 · 2016: 7 · 2015: 5 · 2014: 4 · 2013: 2
FWCI
4.70
Type
journal article
Language
en
Open access
Locations
  • Canadian Journal of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
Keywords
endotracheal intubation, emergency department intubation, risk factors, chronic obstructive pulmonary disease, neuromuscular blocking agents, vasopressor use, in-hospital mortality, airway management
MeSH terms
Emergency Medical Services, Female, Follow-Up Studies, Hemodynamics, Humans, Hypotension, Intubation, Intratracheal, Male, Middle Aged, Nova Scotia, Retrospective Studies, Risk Factors, Time Factors, Incidence, Hospital Mortality, Risk Assessment

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