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BMC Res Notes. 2015 Sep 15;8:445. doi: 10.1186/s13104-015-1410-7.

Vasopressor use as a surrogate for post-intubation hemodynamic instability is associated with in-hospital and 90-day mortality: a retrospective cohort study.

Author information

1
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. smischney.nathan@mayo.edu.
2
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. smischney.nathan@mayo.edu.
3
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. demirci.onur@mayo.edu.
4
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. ricter.bryce@mayo.edu.
5
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. hoeft.christina@mayo.edu.
6
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. johnson.lisa2@mayo.edu.
7
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. ansar.shejan@mayo.edu.
8
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. kashyap.rahul@mayo.edu.

Abstract

BACKGROUND:

Evidence is lacking for what defines post-intubation hypotension in the intensive care unit (ICU). If a valid definition could be used, the potential exists to evaluate possible risk factors and thereby improve post-intubation. Thus, our objectives were to arrive at the best surrogate for post-intubation hypotension that accurately predicts both in-hospital and 90-day mortality in a population of ICU patients and to report mortality rates between the exposed and unexposed cohorts.

METHODS:

We conducted a retrospective cohort study of emergent endotracheal intubations in a medical-surgical ICU from January 1, 2010 to December 31, 2011 to evaluate surrogates for post-intubation hypotension that would predict in-hospital and 90-day mortality followed by an analysis of exposed versus unexposed using our best surrogate. Patients were ≥18 years of age, underwent emergent intubation during their first ICU admission, and did not meet any of the surrogates 60 min pre-intubation.

RESULTS:

The six surrogates evaluated 60 min post-intubation were those with any systolic blood pressures ≤90 mmHg, any mean arterial pressures ≤65 mmHg, reduction in median systolic blood pressures of ≥20%, any vasopressor administration, any non-sinus rhythm and, fluid administration of ≥30 ml/kg. A total of 147 patients were included. Of the six surrogates, only the administration of any vasopressor 60 min post-intubation remained significant for mortality. Twenty-nine patients were then labeled as hemodynamically unstable and compared to the 118 patients labeled as hemodynamically stable. After adjusting for confounders, the hemodynamically unstable group had a significantly higher in-hospital and 90-day mortality [OR (95% CI); 3.84 (1.31-11.57) (p value = 0.01) and 2.37 (1.18-4.61) (p-value = 0.02)].

CONCLUSIONS:

Emergently intubated patients manifesting hemodynamic instability after but not before intubation, as measured by vasoactive administration 60 min post-intubation, have a higher association with in-hospital and 90-day mortality.

PMID:
26374289
PMCID:
PMC4572685
DOI:
10.1186/s13104-015-1410-7
[Indexed for MEDLINE]
Free PMC Article

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