Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study
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 intuba...
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| Veröffentlicht in: | PloS one 2020-08, Vol.15 (8), p.e0233852-e0233852 |
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| creator | Smischney, Nathan J Kashyap, Rahul Khanna, Ashish K Brauer, Ernesto Morrow, Lee E Seisa, Mohamed O Schroeder, Darrell R Diedrich, Daniel A Montgomery, Ashley Franco, Pablo Moreno Ofoma, Uchenna R Kaufman, David A Sen, Ayan Callahan, Cynthia Venkata, Chakradhar Demiralp, Gozde Tedja, Rudy Lee, Sarah Geube, Mariya Kumar, Santhi I Morris, Peter Bansal, Vikas Surani, Salim |
| description | 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. 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 |
| doi_str_mv | 10.1371/journal.pone.0233852 |
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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. 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. 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. A novel multivariable risk score predicted post-intubation hypotension with accuracy in both unstable and stable critically ill patients.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0233852</identifier><identifier>PMID: 32866219</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Adults ; Airway management ; Anesthesiology ; Blood pressure ; Cardiac arrest ; Care and treatment ; Catecholamine ; Catecholamines ; Cohort analysis ; Complications and side effects ; Consortia ; Critical care ; Critically ill persons ; Diuretics ; Etomidate ; Health risks ; Heart ; Hemodynamics ; Hospitals ; Hypotension ; Intratracheal intubation ; Intubation ; Medicine ; Medicine and Health Sciences ; Mortality ; Patients ; Phenylephrine ; Prediction models ; Respiratory failure ; Review boards ; Risk analysis ; Risk factors ; Sepsis ; Sleep ; Supervision</subject><ispartof>PloS one, 2020-08, Vol.15 (8), p.e0233852-e0233852</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Smischney et al. 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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. 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. 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. A novel multivariable risk score predicted post-intubation hypotension with accuracy in both unstable and stable critically ill patients.</description><subject>Adults</subject><subject>Airway management</subject><subject>Anesthesiology</subject><subject>Blood pressure</subject><subject>Cardiac arrest</subject><subject>Care and treatment</subject><subject>Catecholamine</subject><subject>Catecholamines</subject><subject>Cohort analysis</subject><subject>Complications and side effects</subject><subject>Consortia</subject><subject>Critical care</subject><subject>Critically ill persons</subject><subject>Diuretics</subject><subject>Etomidate</subject><subject>Health risks</subject><subject>Heart</subject><subject>Hemodynamics</subject><subject>Hospitals</subject><subject>Hypotension</subject><subject>Intratracheal intubation</subject><subject>Intubation</subject><subject>Medicine</subject><subject>Medicine and Health 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R</au><au>Diedrich, Daniel A</au><au>Montgomery, Ashley</au><au>Franco, Pablo Moreno</au><au>Ofoma, Uchenna R</au><au>Kaufman, David A</au><au>Sen, Ayan</au><au>Callahan, Cynthia</au><au>Venkata, Chakradhar</au><au>Demiralp, Gozde</au><au>Tedja, Rudy</au><au>Lee, Sarah</au><au>Geube, Mariya</au><au>Kumar, Santhi I</au><au>Morris, Peter</au><au>Bansal, Vikas</au><au>Surani, Salim</au><aucorp>On behalf of SCCM Discovery (Critical Care Research Network of Critical Care Medicine) HEMAIR Investigators Consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study</atitle><jtitle>PloS one</jtitle><date>2020-08-31</date><risdate>2020</risdate><volume>15</volume><issue>8</issue><spage>e0233852</spage><epage>e0233852</epage><pages>e0233852-e0233852</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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. 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. 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. A novel multivariable risk score predicted post-intubation hypotension with accuracy in both unstable and stable critically ill patients.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>32866219</pmid><doi>10.1371/journal.pone.0233852</doi><tpages>e0233852</tpages><orcidid>https://orcid.org/0000-0002-4383-3411</orcidid><orcidid>https://orcid.org/0000-0003-1051-098X</orcidid><orcidid>https://orcid.org/0000-0003-0981-4222</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-08, Vol.15 (8), p.e0233852-e0233852 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2438960840 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adults Airway management Anesthesiology Blood pressure Cardiac arrest Care and treatment Catecholamine Catecholamines Cohort analysis Complications and side effects Consortia Critical care Critically ill persons Diuretics Etomidate Health risks Heart Hemodynamics Hospitals Hypotension Intratracheal intubation Intubation Medicine Medicine and Health Sciences Mortality Patients Phenylephrine Prediction models Respiratory failure Review boards Risk analysis Risk factors Sepsis Sleep Supervision |
| title | Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study |
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