Lin et al identiifed risk factors for hypotension following rapid sequence intubation (RSI) in the Emergence Department (ED). This can help to identify a patient who may benefit from more aggressive management. The authors are from Chang Gung Memorial Hospital in Taiwan.
Patient selection: rapid sequence intubation in the ED, age > 18 years, nontraumatic
Exclusions: shock status, cardiac arrest, inotropic agents, esophageal intubation, tube malposition, > 3 attempts
Outcome: hypotension after RSI (systolic blood pressure < 90 mm Hg)
Parameters from logistic regression model:
(1) systolic blood pressure prior to RSI in mm Hg
(2) COPD
(3) sepsis
(4) body weight in kilograms
|
Parameter
|
Finding
|
Odds Ratio
|
|
systolic blood pressure
|
> 140 mm Hg
|
1
|
|
|
<= 140 mm Hg
|
4.1
|
|
COPD
|
no
|
1
|
|
|
yes
|
4.8
|
|
sepsis
|
no
|
1
|
|
|
yes
|
9.9
|
|
body weight
|
> 55 kg
|
1
|
|
|
<= 55 kg
|
3.3
|
cumulative product of odds ratios =
= PRODUCT(odds ratios for the 4 parameters)
Interpretation:
• minimum cumulative product: 1
• maximum cumulative product: 642.95
• The higher the cumulative product the greater the risk for hypotension.
Other risk factors not used in the final model:
(1) hypoalbuminemia, possibly an indicator of fluid shift into extravascular tissues
(2) use of lidocaine for RSI (others were rocurorium, ketamine, midazolam)
