Factors Associated with Postintubation Hypotension Among Patients with Suspected Sepsis in Emergency Department

IF 1.5 Q3 EMERGENCY MEDICINE Open Access Emergency Medicine Pub Date : 2023-11-01 DOI:10.2147/oaem.s426822
Panvilai Tangkulpanich, Chuenruthai Angkoontassaneeyarat, Thavinee Trainarongsakul, Chetsadakon Jenpanitpong
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Abstract

Purpose: Postintubation hypotension (PIH) is a recognized complication that increases both in-hospital mortality and hospital length of stay. Sepsis is reportedly a factor associated with PIH. However, no study to date has examined which factors, including the intubation method, may be clinical predictors of PIH in patients with sepsis. This study aims to investigate factors associated with the occurrence of PIH in patients with suspected sepsis in emergency department. Patients and Methods: This retrospective cross-sectional study was performed over a 5-year period (January 2013–December 2017) and involved patients with suspected sepsis who underwent endotracheal intubation in the emergency department of Ramathibodi Hospital. The patients were divided into those with and without PIH, and factors associated with the occurrence of PIH were analyzed. PIH was defined as any recorded systolic blood pressure of < 90 mmHg within 60 minutes of intubation. Results: In total, 394 patients with suspected sepsis were included. PIH occurred in 106 patients (26.9%) and was associated with increased in-hospital mortality (43.00% in the PIH group vs 31.25% in the non-PIH group, P = 0.034). Multivariable logistic regression showed that the factors associated with PIH were an age of ≥ 61 years (adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.14– 4.43; P = 0.019) and initial serum lactate concentration of > 4.4 mmol/L (aOR 2.00; 95% CI 1.16– 3.46; P = 0.013). Rapid sequence intubation and difference types of induction agents was unrelated to PIH. Conclusion: Monitoring the development of PIH in patients with sepsis is essential because of its correlation with higher in-hospital mortality. This is particularly critical for older individuals and those with severe infections and high initial lactate concentrations. Keywords: postintubation hypotension, sepsis, emergency department intubation
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急诊疑似脓毒症患者插管后低血压的相关因素分析
目的:插管后低血压(PIH)是一种公认的并发症,可增加住院死亡率和住院时间。脓毒症是PIH的一个相关因素。然而,迄今为止还没有研究检查哪些因素(包括插管方法)可能是脓毒症患者PIH的临床预测因素。本研究旨在探讨急诊疑似脓毒症患者发生PIH的相关因素。患者和方法:这项回顾性横断面研究进行了5年时间(2013年1月- 2017年12月),涉及在Ramathibodi医院急诊科接受气管插管的疑似脓毒症患者。将患者分为有PIH组和无PIH组,分析发生PIH的相关因素。PIH定义为插管后60分钟内任何记录的收缩压< 90mmhg。结果:共纳入疑似脓毒症患者394例。106例(26.9%)患者发生PIH,并与住院死亡率增加相关(PIH组43.00% vs非PIH组31.25%,P = 0.034)。多变量logistic回归显示,与PIH相关的因素为年龄≥61岁(校正优势比[aOR] 2.25;95%置信区间[CI] 1.14 - 4.43;P = 0.019),初始血清乳酸浓度> 4.4 mmol/L (aOR 2.00;95% ci 1.16 - 3.46;P = 0.013)。快速序贯插管和不同类型诱导剂与PIH无关。结论:监测脓毒症患者PIH的发展是必要的,因为它与较高的住院死亡率相关。这对老年人和严重感染和初始乳酸浓度高的人尤其重要。关键词:插管后低血压,败血症,急诊科插管
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来源期刊
Open Access Emergency Medicine
Open Access Emergency Medicine EMERGENCY MEDICINE-
CiteScore
2.60
自引率
6.70%
发文量
85
审稿时长
16 weeks
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