Patient selection: emergency airway management
Post-intubation hypotension (PIH) was defined as systolic blood pressure < 90 mm Hg during the 60 minutes after emergency intubation.
Risk factors identified on logistic regression analysis:
(1) elevated shock index (SI): >= 0.8 (normal 0.5 to 0.7)
(2) reason for intubation acute respiratory failure
(3) older adult
(4) chronic renal disease (chronic renal insufficiency or end-stage renal disease)
where:
• The shock index = (heart rate) / (systolic blood pressure).
• A cutoff for age was not given. The PIH absent group was 48 +/- 19 (up to 67). The PIH present group was 54 +/- 20), so considerable overlap present. Age > 60 will be used in the implementation.
Additional risk factors:
(1) diabetes mellitus
(2) COPD
(3) left ventricular dysfunction (which would be associated with the SI)
(4) acute sepsis
Factors associated with reduced risk:
(1) chronic angiotensin-converting enzyme (ACE) inhibitor therapy
(2) rapid sequence intubation paralysis
A patient showing PIH is at increased risk for complications such as in-hospital mortality. Recognition of PIH identifies a high-risk patient who may benefit from more aggressive management.
