(1396) Incidence and Predictors of Postintubation Hypotension Among Normotensive Adults

Introduction: Hypotension is a serious complication of endotracheal intubation which can be mitigated if anticipated. We sought to determine the incidence and pre-intubation factors associated with post-intubation hypotension among normotensive adults intubated in the emergency department (ED).

Methods: Retrospective chart review of adults intubated in 8 hospital EDs in a regional healthcare system in 2019. Adults with an ED intubation procedure were included. Data were extracted by trained research assistants blinded to the hypothesis and entered into REDCap. Demographic information and details about the peri-intubation course were extracted. Hypotension was defined as systolic blood pressure (SBP) < 90 or mean arterial pressure < 65. Hypotensive patients pre-intubation were excluded. Data were uploaded to SAS 9.4 and analyzed using Chi-square for ordinal data and Student's t test for continuous variables, following normality testing with Shapiro Wilk and log transformation. Uni- and multivariate analyses were performed to determine factors associated with the development of post-intubation hypotension.

Results: Data from 1693 intubations were extracted; 403 were excluded secondary to pre-intubation hypotension or missing data, for a final cohort of 1290. Median age was 60 [48-71]; 56% were male; 62% were black. Common reasons for intubation included airway protection (54%) and acute respiratory failure (39%). Post-intubation hypotension occurred in 267 (21%) patients. Pre-intubation factors associated with the development of post-intubation hypotension include age (OR 1.01, CI 1.01-1.02), initial SBP (OR 0.98, CI 1.01-1.1), active malignancy (OR 1.9, CI 1.20-3.03), shock index, (OR 2.28, CI 1.40-3.71), and set RR (OR 1.05, CI 1.01-1.10). In multivariable analysis, age (OR 1.01, CI 1.001-1.02), initial SBP (OR 0.99, CI 0.98-0.99) and acute respiratory failure as reason for intubation (OR 1.87, CI 1.40-2.49) remained significant. Shock index was removed from multivariate analysis due to collinearity with initial SBP.

Conclusions: The incidence of post-intubation hypotension in normotensive patients intubated in the ED was 21% in this multicenter study involving undifferentiated adults. Age, initial SBP, and the reason for intubation were independently associated with developing post-intubation hypotension.