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J Crit Care. 2015 Oct;30(5):1055-60. doi: 10.1016/j.jcrc.2015.06.007. Epub 2015 Jun 16.

Postintubation hypotension in intensive care unit patients: A multicenter cohort study.

Author information

1
Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Trauma Nova Scotia, Halifax, Nova Scotia, Canada. Electronic address: greenrs@dal.ca.
2
CHU de Québec Research Center, Hôpital de L'Enfant-Jésus, Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine Group), Université Laval, Québec City, Québec, Canada; Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada. Electronic address: alexis.turgeon@fmed.ulaval.ca.
3
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: lmcintyre@ohri.ca.
4
Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, David Braley Research Institute, Hamilton, Ontario, Canada. Electronic address: afoxrob@mcmaster.ca.
5
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: dafergusson@ohri.ca.
6
Department of Community Health and Epidemiology (Capital Health, Dalhousie University, IWK Health Centre), Centre for Clinical Research, Halifax, Nova Scotia, Canada. Electronic address: Steve.Doucette@nshealth.ca.
7
Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: mbbutler@dal.ca.
8
Trauma Nova Scotia, Halifax, Nova Scotia, Canada. Electronic address: mete.erdogan@nshealth.ca.

Abstract

PURPOSE:

To determine the incidence of postintubation hypotension (PIH) and associated outcomes in critically ill patients requiring endotracheal intubation.

MATERIALS AND METHODS:

Medical records were reviewed for 479 consecutive critically ill adult patients who required intubation by an intensive care unit (ICU) service at 1 of 4 academic tertiary care hospitals. The primary outcome measure was the incidence of PIH. Secondary outcome measures included mortality, ICU length of stay, requirement for renal replacement therapy, and a composite end point consisting of overall mortality, ICU length of stay greater than 14 days, duration of mechanical ventilation longer than 7 days, and renal replacement therapy requirement.

RESULTS:

Overall, the incidence of PIH among ICU patients requiring intubation was 46% (218/479 patients). On univariate analysis, patients who developed PIH had increased ICU mortality (37% PIH vs 28% no PIH, P = .049) and overall mortality (39% PIH vs 30% no PIH, P = .045). After adjusting for important risk factors, development of PIH was associated with the composite end point of major morbidity and mortality (odds ratio, 2.00; 95% confidence interval, 1.30-3.07; P = .0017).

CONCLUSIONS:

The development of PIH is common in ICU patients requiring emergency airway control and is associated with poor patient outcomes.

KEYWORDS:

Airway management; Hemodynamics; Intensive care units; Intratracheal; Intubation; Multicenter study

PMID:
26117220
DOI:
10.1016/j.jcrc.2015.06.007
[Indexed for MEDLINE]

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