Chloe Verwiel
Medical Student
Georgetown University School of Medicine
Washington, District of Columbia
Disclosure information not submitted.
Munish Goyal, MD
Professor
Georgetown University/MedStar Health
Washington, District of Columbia, United States
Disclosure information not submitted.
Gail Drescher, MA RRT-ACCS CTTS
Respiratory Therapy Clinical Specialist
MedStar Washington Hospital Center, United States
Disclosure information not submitted.
Schuyler Gaillard, BS
Medical Student
Georgetown University School of Medicine, United States
Disclosure information not submitted.
Jacqueline Barnes, BS
Medical Student
Georgetown University School of Medicine, United States
Disclosure information not submitted.
Title: The Incidence of Post-intubation Hypotension among Adults Intubated in the Emergency Department
Introduction: Hypotension is a known complication of endotracheal intubation (ETI) that is independently associated with mortality and can be mitigated with push-dose vasopressors. We sought to determine the incidence of post-intubation hypotension among adults intubated in the emergency department (ED) that were normotensive pre-intubation and hypothesized that the incidence would be less than 10%.
Methods: Retrospective chart review of patients intubated in the EDs of eight hospitals in a regional healthcare system including large, urban academic medical centers and small, suburban community hospitals over a four month period in 2019. Adults 18 years or older with an ETI procedure note completed in the ED were included. Data were extracted by trained and supervised research assistants blinded to the hypothesis and entered into a REDCap database. Basic demographic information and details about the intubation and post-intubation ED course were extracted. Patients were dichotomized based on pre-intubation blood pressure. Hypotension was defined as a systolic blood pressure less than 90 or a mean arterial pressure less than 65. Following this definition, any documented hypotension post-intubation while in the ED was noted. Simple descriptive statistics were employed.
Results: Data from 368 patients were extracted. Six were excluded because intubation did not occur in the ED, leaving a final cohort of 362 for analysis. Mean age is 60.2, 55.3% male, 59.9% black, 32.9% white. The reasons for intubation include airway protection (48.1%) and acute respiratory failure (41.2%). Fifty-three (14.6%) patients who were normotensive prior to intubation became hypotensive post-intubation. In-hospital mortality rate was similar in both groups, 28.3% of hypotensive vs 27.2% not hypotensive.
Conclusions: The incidence of post-intubation hypotension in normotensive patients intubated in the ED is 14.6% in this multicenter study involving undifferentiated adults. This is higher than we expected and prompts consideration of having rapid access to vasoactive medication and intravenous fluid when performing rapid sequence intubation.