PURPOSE: Airway management and hemodynamic support are priorities of critical care. Systemic hypotension is a common clinical situation but is poorly described as a consequence of airway management. We aimed to identify the incidence and duration of post-intubation hypotension (PIH) among adult patients undergoing emergency airway management by critical care specialists at a university medical center.
METHODS: Cardiopulmonary resuscitation records of all Medical Emergency Team (MET) responses at the University of Pittsburgh Medical Center from July 2005 to February 2006 were systematically reviewed. Drugs used to facilitate intubation, serial pre- and post-intubation blood pressure recordings, presence and duration of PIH, and use of vasopressors were extracted from each record documenting endotracheal intubation. PIH was defined as a fall in systolic blood pressure (SBP) <90mm Hg in a patient with SBP>90mm Hg prior to intubation. Patients with SBP<90mm Hg or cardiac arrest prior to airway management were excluded from analysis.
RESULTS: The MET responded to 537 events outside of the intensive care unit, of which 102 (19%) required emergency airway management. Twenty-two patients experienced pre-intubation hypotension or cardiac arrest and were excluded from analysis; the remaining 80 patients constitute the study cohort. Etomidate was used to facilitate intubation in 68% of cases; 38% of patients received muscle relaxants. PIH occurred in 24 patients (30%; 95% CI: 21-41%). Fourteen of these patients (58%; 95% CI: 39-76%) experienced hypotension lasting longer than 10 minutes and 5 patients (21%; 95% CI: 9-41%) received vasopressor support.
CONCLUSION: Post-intubation hypotension occurs in 30% of patients undergoing emergency airway management. Patients frequently experience continuous hypotension lasting longer than 10 minutes despite active management by the MET.
CLINICAL IMPLICATIONS: Emergency airway managers should anticipate and prepare for post-intubation hypotension. Prospective evaluation of patient characteristics and outcomes are necessary to draw final conclusions on the significance of post-intubation hypotension.
DISCLOSURE: Alan Heffner, No Financial Disclosure Information; No Product/Research Disclosure Information