Heffner et al identified risk factors associated with postintubation hypotension (PIH) associated with emergency airway management. These can help to identify patients who may require more aggressive management. The authors are from Carolinas Medical Center in Charlotte and the University of Mississippi in Jackson.


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)



• 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.


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