TY - JOUR
T1 - Risk factors for and prediction of postintubation hypotension in critically ill adults
T2 - A multicenter prospective cohort study
AU - On behalf of SCCM Discovery (Critical Care Research Network of Critical Care Medicine) HEMAIR Investigators Consortium¶
AU - Smischney, Nathan J.
AU - Kashyap, Rahul
AU - Khanna, Ashish K.
AU - Brauer, Ernesto
AU - Morrow, Lee E.
AU - Seisa, Mohamed O.
AU - Schroeder, Darrell R.
AU - Diedrich, Daniel A.
AU - Montgomery, Ashley
AU - Franco, Pablo Moreno
AU - Ofoma, Uchenna R.
AU - Kaufman, David A.
AU - Sen, Ayan
AU - Callahan, Cynthia
AU - Venkata, Chakradhar
AU - Demiralp, Gozde
AU - Tedja, Rudy
AU - Lee, Sarah
AU - Geube, Mariya
AU - Kumar, Santhi I.
AU - Morris, Peter
AU - Bansal, Vikas
AU - Surani, Salim
N1 - Publisher Copyright:
© 2020 Smischney et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2020/8
Y1 - 2020/8
N2 - Objective Hypotension following endotracheal intubation in the ICU is associated with poor outcomes. There is no formal prediction tool to help estimate the onset of this hemodynamic compromise. Our objective was to derive and validate a prediction model for immediate hypotension following endotracheal intubation. Methods A multicenter, prospective, cohort study enrolling 934 adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 was conducted to derive and validate a prediction model for immediate hypotension following endotracheal intubation. We defined hypotension as: 1) mean arterial pressure <65 mmHg; 2) systolic blood pressure <80 mmHg and/or decrease in systolic blood pressure of 40% from baseline; 3) or the initiation or increase in any vasopressor in the 30 minutes following endotracheal intubation. Results Post-intubation hypotension developed in 344 (36.8%) patients. In the full cohort, 11 variables were independently associated with hypotension: increasing illness severity; increasing age; sepsis diagnosis; endotracheal intubation in the setting of cardiac arrest, mean arterial pressure <65 mmHg, and acute respiratory failure; diuretic use 24 hours preceding endotracheal intubation; decreasing systolic blood pressure from 130 mmHg; catecholamine and phenylephrine use immediately prior to endotracheal intubation; and use of etomidate during endotracheal intubation. A model excluding unstable patients’ pre-intubation (those receiving catecholamine vasopressors and/or who were intubated in the setting of cardiac arrest) was also developed and included the above variables with the exception of sepsis and etomidate. In the full cohort, the 11 variable model had a C-statistic of 0.75 (95% CI 0.72, 0.78). In the stable cohort, the 7 variable model C-statistic was 0.71 (95% CI 0.67, 0.75). In both cohorts, a clinical risk score was developed stratifying patients’ risk of hypotension. Conclusions A novel multivariable risk score predicted post-intubation hypotension with accuracy in both unstable and stable critically ill patients.
AB - Objective Hypotension following endotracheal intubation in the ICU is associated with poor outcomes. There is no formal prediction tool to help estimate the onset of this hemodynamic compromise. Our objective was to derive and validate a prediction model for immediate hypotension following endotracheal intubation. Methods A multicenter, prospective, cohort study enrolling 934 adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 was conducted to derive and validate a prediction model for immediate hypotension following endotracheal intubation. We defined hypotension as: 1) mean arterial pressure <65 mmHg; 2) systolic blood pressure <80 mmHg and/or decrease in systolic blood pressure of 40% from baseline; 3) or the initiation or increase in any vasopressor in the 30 minutes following endotracheal intubation. Results Post-intubation hypotension developed in 344 (36.8%) patients. In the full cohort, 11 variables were independently associated with hypotension: increasing illness severity; increasing age; sepsis diagnosis; endotracheal intubation in the setting of cardiac arrest, mean arterial pressure <65 mmHg, and acute respiratory failure; diuretic use 24 hours preceding endotracheal intubation; decreasing systolic blood pressure from 130 mmHg; catecholamine and phenylephrine use immediately prior to endotracheal intubation; and use of etomidate during endotracheal intubation. A model excluding unstable patients’ pre-intubation (those receiving catecholamine vasopressors and/or who were intubated in the setting of cardiac arrest) was also developed and included the above variables with the exception of sepsis and etomidate. In the full cohort, the 11 variable model had a C-statistic of 0.75 (95% CI 0.72, 0.78). In the stable cohort, the 7 variable model C-statistic was 0.71 (95% CI 0.67, 0.75). In both cohorts, a clinical risk score was developed stratifying patients’ risk of hypotension. Conclusions A novel multivariable risk score predicted post-intubation hypotension with accuracy in both unstable and stable critically ill patients.
UR - http://www.scopus.com/inward/record.url?scp=85090101776&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0233852
DO - 10.1371/journal.pone.0233852
M3 - Article
C2 - 32866219
AN - SCOPUS:85090101776
SN - 1932-6203
VL - 15
JO - PloS one
JF - PloS one
IS - 8 August
M1 - e0233852
ER -