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J Crit Care. 2018 Apr;44:179-184. doi: 10.1016/j.jcrc.2017.10.018. Epub 2017 Oct 16.

Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management-Part II.

Author information

1
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: smischney.nathan@mayo.edu.
2
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: seisa.mohamed@mayo.edu.
3
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: heise.katherine@mayo.edu.
4
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: wiegand.robert@mayo.edu.
5
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: busack.kyle@mayo.edu.
6
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: Deangelis.jillian@mayo.edu.
7
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: loftsgard.theodore@mayo.edu.
8
Department of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: schroeder.darrell@mayo.edu.
9
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. Electronic address: diedrich.daniel@mayo.edu.

Abstract

PURPOSE:

Our primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period.

METHODS:

We conducted a nested case-control study of a previously identified cohort of adult patients needing intubation admitted to a medical-surgical ICU during 2013-2014. Hemodynamic derangement was defined as cardiac arrest and/or the development of systolic blood pressure <90mmHg and/or mean arterial pressure <65mmHg 30min following intubation. Data during the peri-intubation period was analyzed.

RESULTS:

The final cohort included 420 patients. Immediate hemodynamic derangement occurred in 170 (40%) patients. On multivariate modeling, age/10year increase (OR 1.20, 95% CI 1.03-1.39, p=0.02), pre-intubation non-invasive ventilation (OR 1.71, 95% CI 1.04-2.80, p=0.03), pre-intubation shock index/1 unit (OR 5.37 95% CI 2.31-12.46, p≤0.01), and pre-intubation modified shock index/1 unit (OR 2.73 95% CI 1.48-5.06, p≤0.01) were significantly associated with hemodynamic derangement. Those experiencing hemodynamic derangement had higher ICU [47 (28%) vs. 33 (13%); p≤0.001] and hospital [69 (41%) vs. 51 (20%); p≤0.001] mortality.

CONCLUSIONS:

Hemodynamic derangement occurred at a rate of 40% and was associated with increased mortality. Increasing age, use of non-invasive ventilation before intubation, and increased pre-intubation shock and modified shock index values were significantly associated with hemodynamic derangement post-intubation.

KEYWORDS:

Critically ill; Hemodynamic management; Hypotension; Intensive care unit; Intubation; Nested case-control study

PMID:
29132057
DOI:
10.1016/j.jcrc.2017.10.018
[Indexed for MEDLINE]

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