University of Maryland School of Medicine

Department of Emergency Medicine

University of Maryland School of Medicine Department of Emergency Medicine

UMEM Educational Pearls

Postintubation Hypotension

  • It is clear that preintubation hypotension is associated with increased mortality in critically ill patients who require mechanical ventilation.
  • Unfortunatley, the literature is less clear on the frequency and impact of hypotension that develops after intubation.
  • Two recent publications in the Journal of Intensive Care provide valuable information on postintubation hypotension.  Some highlights of the studies include:
    • Retrospective cohorts of over 300 patients who developed postintubation hypotension, defined as a SBP < 90 mm Hg within 60 min of intubation.
    • Postintubation hypotension occurred in almost 25% of patients.
    • Median time to hypotension was 11 minutes.
    • Patients with postintubation hypotension had a higher inhospital mortality (33% vs. 23%).
    • A preintubation Shock Index > 0.8 was the strongest predictor of cardiovascular collapse after intubation.
  • Take Home Point: Postintubation hypotension occurs frequently and may be associated with worse outcomes.

References

Heffner AC, Swords D, Kline JA, et al. The frequency and significance of postintubation hypotension during emergency airway management. J Crit Care 2012; 27:417e9-417e13.

Heffner AC, Swords D, Nussbaum ML, et al. Predictors of the complication of postintubation hypotension during emergency airway management. J Crit Care 2012; 27:587-593.