(238) Assess the Impact of Shock Index as a Prognosticator of Post-Intubation Hypotension

Introduction: Patients undergoing rapid sequence intubation (RSI) are at a high risk of developing complications such as postintubation hypotension (PIH). The objective of our study is to evaluate the utilization of pre-intubation shock index (SI) to predict the development of PIH in patients undergoing RSI.

Methods: A single-center retrospective cohort study comparing patients undergoing RSI with an elevated SI (≥ 0.9) compared to a normal-to-low SI ( < 0.9). Adult patients were included if hemodynamically stable prior to RSI (defined as SBP > 90, MAP > 65, and no vasopressor support within 30 minutes of the procedure). Patients were excluded if intubation occurred during or within 30 minutes after cardiac arrest, no induction agent used to perform RSI, dexmedetomidine used within 30 minutes of RSI, no vital signs documented within 30 minutes of RSI, or if intubation was performed in the operating room. The primary outcome was development of post-intubation hypotension (defined as SBP ≤ 90, MAP ≤ 65, new vasopressor administration, or ≥500 mL fluid bolus) within 30 minutes of RSI. Secondary outcomes include incidence of PIH per induction agent, cardiac arrest, vasopressor use within 30 minutes of RSI, ICU and hospital length of stay, and in-hospital all-cause mortality.

Results: 185 patients were evaluated, 137 in the SI < 0.9 and 48 in the SI ≥0.9 cohort. Baseline characteristics demonstrated most patients were male (58.9%) being intubated in the emergency department (98.4%) for the indication of airway protection (92.9%). PIH developed in 18.2% of patients with a SI < 0.9 compared to 43.8% in the SI ≥0.9 cohort (p-value < 0.0001). No difference was observed in the time on the ventilator (1.5 vs 1.7 days) ICU length of stay (2.7 vs 2.9 days) hospital length of stay (5.9 vs 7.5 days), ICU mortality (12.4% vs 10.4%) or in-hospital all-cause mortality (3.6% vs 4.2%) in the SI < 0.9 and SI ≥0.9 cohorts, respectively. Cardiac arrest within 30 minutes of RSI was uncommon, occurring in 0.7% of the SI < 0.9 group compared to 2.1% in the SI ≥0.9 group (p = 0.435).

Conclusions: Pre-intubation shock index was found to be a readily available bedside clinical tool to predict patients at risk of developing post-intubation hypotension during RSI.