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Increased mortality in trauma patients who develop postintubation hypotension

Green, Robert S. MD; Butler, Michael B. MD; Erdogan, Mete PhD

Journal of Trauma and Acute Care Surgery: October 2017 - Volume 83 - Issue 4 - p 569–574
doi: 10.1097/TA.0000000000001561
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BACKGROUND Postintubation hypotension (PIH) is common and associated with poor outcomes in critically ill patient populations requiring emergency endotracheal intubation (ETI). The importance of PIH in the trauma population remains unclear. The objective of this study was to determine the prevalence of PIH in trauma patients and assess the association of PIH with patient outcomes.

METHODS Retrospective case series of adult (≥16 years) patients who were intubated on arrival at a tertiary trauma center in Halifax, Nova Scotia, Canada, between 2000 and 2015. Data were collected from the Nova Scotia Trauma Registry and patient chart, and included demographics, comorbidities, trauma characteristics, intubation time, as well as all fluids, medications, adverse events, interventions, and vital signs during the 15 minutes before/after ETI. We evaluated the prevalence of PIH and created a logistic regression model to determine likelihood of mortality in the PIH and non-PIH groups after controlling for patient and provider characteristics.

RESULTS Overall, 477 patients required ETI on assessment by the trauma service, of which 444 patients met eligibility criteria and were included in the analysis. The prevalence of PIH was 36.3% (161 of 444) in our study population. In-hospital mortality occurred in 29.8% (48 of 161) of patients in the PIH group, compared with 15.9% (45 of 283) of patients in the non-PIH group (p = 0.001). Development of PIH was associated with increased mortality in the emergency department (adjusted odds ratio, 3.45; 95% confidence interval, 1.42–8.36) and in-hospital (adjusted odds ratio, 1.83; 95% confidence interval, 1.01–3.31).

CONCLUSION In our study of trauma patients requiring ETI, development of PIH was common (36.3%) and associated with increased mortality. Intubation practices in critically ill trauma patients is an important patient safety issue that requires further investigation.

LEVEL OF EVIDENCE Prognostic and epidemiological, level III; Level IV, Therapeutic.

From the Department of Critical Care (R.S.G., M.B.B.), Dalhousie University, Halifax, NS, Canada; and Trauma Nova Scotia, Nova Scotia Department of Health and Wellness (R.S.G., M.E.), Halifax, NS, Canada.

Submitted: January 26, 2017, Revised: March 9, 2017, Accepted: April 30, 2017, Published online: May 22, 2017.

Presentations at conferences: This study was presented at the 29th annual meeting of the European Society of Intensive Care Medicine, October 1–5, 2017 in Milan, Italy. This study was also presented at the annual meeting of the Trauma Association of Canada, February 23–24, 2017 in Vancouver, British Columbia.

Address for reprints: Robert S. Green, MD, Room 377 Bethune Building, 1276 South Park Street, Halifax, NS, Canada, B3H 2Y9; email: greenrs@dal.ca.

© 2017 Lippincott Williams & Wilkins, Inc.