Hypotension after intubation and initiation of mechanical ventilation
Approximately 25-30% of patients develop hypotension after intubation and initiation of mechanical ventilation (MV).
Although the literature is not robust, risk factors for hypotension after initiation of MV include:
hypotension prior to intubation
tachycardia prior to intubation
obesity
high intrathoracic pressure (COPD)
excess catecholamine states (ETOH withdrawal, cocaine intoxication) with rapid relaxation during RSI
In addition to administering isotonic intravenous fluids (IVFs) while preparing for intubation, consider having a vasopressor medication, such as phenylephrine, available if IVFs alone prove insufficient at maintaining blood pressure.
References
Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. JEM 2010; 38:622-31.
