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Risk factors of peri-intubation cardiovascular collapse in critically ill patients

Year 2024, Volume: 29 Issue: 2, 110 - 119, 29.05.2024
https://doi.org/10.21673/anadoluklin.1310223

Abstract

Aim: Peri-intubation cardiovascular collapse is a common side effect of tracheal intubation and is associated with increased mortality in critically ill patients. We aimed to determine the potential risk factors associated with peri-intubation cardiovascular collapse.

Methods: This is a prospective observational study of patients who were critically ill and undergoing tracheal intubation from August 1, 2022 to February 28, 2023. The primary outcome was peri-intubation cardiovascular collapse. Peri-intubation cardiovascular collapse was defined as systolic blood pressure <65 mm Hg or new or increased need for vasopressors between induction and 2 minutes after tracheal intubation, or cardiac arrest or death between induction of anesthesia and 1 hour after tracheal intubation.

Results: A total of 87 eligible patients were included. Of them, 37 (42.5%) had peri-intubation cardiovascular collapse. Multivariate logistic regression analysis showed that a shock index ≥ 0.90 (odds ratio [OR] 9.87, 95% confidence interval [CI] 2.98–32.70, p<0.001) and older age (OR 1.07, 95%CI 1.01–1.13, p=0.013) were independent risk factors for peri-intubation cardiovascular collapse. The mortality rate was similar in patients with and without peri-intubation cardiovascular collapse (56.8% vs. 42.0%; p=0.198).

Conclusion: The incidence of peri-intubation cardiovascular collapse is high in critically ill patients. Precautions should be taken because of the increased risk of peri-intubation cardiovascular collapse in elderly patients and patients with a shock index ≥ 0.90.

References

  • Simpson GD, Ross MJ, McKeown DW, Ray DC. Tracheal intubation in the critically ill: A multi-centre national study of practice and complications. Br J Anaesth. 2012;108(5):792–9.
  • Smischney NJ, Demirci O, Diedrich DA, et al. Incidence of and risk factors for post-intubation hypotension in the critically Ill. Med Sci Monit. 2016;22:346–55.
  • de Jong A, Rolle A, Molinari N, et al. Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study. Crit Care Med. 2018;46(4):532–9.
  • Shafi S, Gentilello L, Salomone JP,et al. Pre-hospital endotracheal intubation and positive pressure ventilation is associated with hypotension and decreased survival in hypovolemic trauma patients: An analysis of the national trauma data bank. J Trauma - Inj Infect Crit Care. 2005;59(5):1140–7.
  • Smischney NJ, Seisa MO, Cambest J, et al. The Incidence of and Risk Factors for Postintubation Hypotension in the Immunocompromised Critically Ill Adult. J Intensive Care Med. 2019;34(7):578–86.
  • Ergün B, Ergan B, Yakar MN, et al. Incidência e fatores de risco para hipotensão pós-intubação em pacientes críticos com COVID-19. Rev Bras Ter intensiva. 2022;34(1):131–40.
  • Russotto V, Tassistro E, Myatra SN, et al. Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill Insights from the INTUBE Study. Am J Respir Crit Care Med. 2022;206(4):449–58.
  • Russell DW, Casey JD, Gibbs KW, et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022;328(3):270-9.
  • Janz DR, Casey JD, Semler MW, et al. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. Lancet Respir Med. 2019;7(12):1039–47.
  • Trivedi S, Demirci O, Arteaga G, Kashyap R, Smischney NJ. Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes. J Crit Care. 2015;30(4):861.e1-861.e8617.
  • Lally F, Crome P. Understanding frailty. Postgrad Med J. 2007;83(975):16–20.
  • Fleg JL, Strait J. Age-associated changes in cardiovascular structure and function: A fertile milieu for future disease. Heart Fail Rev. 2012;17(4–5):545–54.
  • Halliday SJ, Casey JD, Rice TW, et al. Risk Factors for Cardiovascular Collapse during Tracheal Intubation of Critically III Adults. Ann Am Thorac Soc. 2020;17(8):1021–4.
  • Zuin M, Rigatelli G, Dell’Avvocata F, et al. Ketamine and midazolam differently impact post-intubation hemodynamic profile when used as induction agents during emergency airway management in hemodynamically stable patients with ST elevation myocardial infarction. Heart Vessels. 2018;33(3):213–25.
  • Dubée V, Hariri G, Joffre J, et al. Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability. Ann Intensive Care. 2022;12(1):68.
  • Smischney NJ, Kashyap R, Khanna AK, et al. Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study. PLoS One. 2020;15(8):e0233852.
  • Allgöwer M, Burri C. "Schockindex" ["Shock index"]. Dtsch Med Wochenschr. 1967;92(43):1947-50.
  • Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: The Framingham heart study. Circulation. 2003;107(23):2920–5.
  • Fleck A, Hawker F, Wallace PI, et al. Increased Vascular Permeability: a Major Cause of Hypoalbuminaemia in Disease and Injury. Lancet. 1985;325(8432):781–4.
  • Starling EH. On the Absorption of Fluids from the Connective Tissue Spaces. J Physiol. 1896;19(4):312–26.
  • Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - J Am Med Assoc. 2016;315(8):801–10.

Yoğun bakım hastalarında endotrakeal entübasyon esnasında gelişen kardiyovasküler kollapsa etki eden risk faktörleri

Year 2024, Volume: 29 Issue: 2, 110 - 119, 29.05.2024
https://doi.org/10.21673/anadoluklin.1310223

Abstract

Amaç: Kardiyovasküler kollaps, yoğun bakım hastalarında trakeal entübasyon esnasında sıklıkla meydana gelen ve mortaliteyi arttıran bir komplikasyondur. Biz bu çalışmada, trakeal entübasyon esnasında kardiyovasküler kollapsa neden olan risk faktörlerini araştırmayı amaçladık.

Yöntemler: Bu çalışma, 1 Ağustos 2022 ile 28 Şubat 2023 tarihleri arasında yoğun bakımda yatan ve trakeal entübasyon uygulanan hastalar üzerinde yapılan prospektif gözlemsel bir çalışmadır. Çalışmanın primer sonlanım noktası kardiyovasküler kollapstı. Kardiyovasküler kollaps, indüksiyonun başlangıcından trakeal entübasyondan sonraki 2. dakikaya kadar olan sürede sistolik kan basıncının 65 mm Hg altına düşmesi veya yeni vazopresör ihtiyacının ortaya çıkması veya zaten vazopresör alanlarda ihtiyacın artması veya indüksiyonun başlangıcından trakeal entübasyondan sonraki 1. saate kadar olan sürede kardiyak arrest veya ölüm saptanması olarak tanımlandı.

Bulgular: Toplam 87 hasta çalışmaya dahil edildi. Bu hastaların 37’sinde (%42,5) kardiyovasküler kollaps meydana geldi. Lojistik regresyon analizinde, şok indeksinin 0,90 ve/veya üzerinde olması (OR 9,87, %95CI 2,98–32,70, p<0,001) ve ileri yaş (OR 1,07, %95CI 1,01–1,13, p=0,013) kardiyovasküler kollaps için bağımsız risk faktörleri olarak bulundu. Mortalite oranı kardiyovasküler kollaps olan (%56,8) ve olmayan hastalarda (%42,0) benzer bulundu (p=0,198).

Sonuç: Yoğun bakım hastalarında trakeal entübasyon esnasında gelişen kardiyovasküler kollaps insidansı yüksektir. Yaşlı hastalarda ve şok indeksi ≥ 0.90 olan hastalarda kardiyovasküler kollaps riskinin artması nedeniyle uygun önlemler alınmalıdır.

References

  • Simpson GD, Ross MJ, McKeown DW, Ray DC. Tracheal intubation in the critically ill: A multi-centre national study of practice and complications. Br J Anaesth. 2012;108(5):792–9.
  • Smischney NJ, Demirci O, Diedrich DA, et al. Incidence of and risk factors for post-intubation hypotension in the critically Ill. Med Sci Monit. 2016;22:346–55.
  • de Jong A, Rolle A, Molinari N, et al. Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients: A Multicenter Cohort Study. Crit Care Med. 2018;46(4):532–9.
  • Shafi S, Gentilello L, Salomone JP,et al. Pre-hospital endotracheal intubation and positive pressure ventilation is associated with hypotension and decreased survival in hypovolemic trauma patients: An analysis of the national trauma data bank. J Trauma - Inj Infect Crit Care. 2005;59(5):1140–7.
  • Smischney NJ, Seisa MO, Cambest J, et al. The Incidence of and Risk Factors for Postintubation Hypotension in the Immunocompromised Critically Ill Adult. J Intensive Care Med. 2019;34(7):578–86.
  • Ergün B, Ergan B, Yakar MN, et al. Incidência e fatores de risco para hipotensão pós-intubação em pacientes críticos com COVID-19. Rev Bras Ter intensiva. 2022;34(1):131–40.
  • Russotto V, Tassistro E, Myatra SN, et al. Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill Insights from the INTUBE Study. Am J Respir Crit Care Med. 2022;206(4):449–58.
  • Russell DW, Casey JD, Gibbs KW, et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022;328(3):270-9.
  • Janz DR, Casey JD, Semler MW, et al. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. Lancet Respir Med. 2019;7(12):1039–47.
  • Trivedi S, Demirci O, Arteaga G, Kashyap R, Smischney NJ. Evaluation of preintubation shock index and modified shock index as predictors of postintubation hypotension and other short-term outcomes. J Crit Care. 2015;30(4):861.e1-861.e8617.
  • Lally F, Crome P. Understanding frailty. Postgrad Med J. 2007;83(975):16–20.
  • Fleg JL, Strait J. Age-associated changes in cardiovascular structure and function: A fertile milieu for future disease. Heart Fail Rev. 2012;17(4–5):545–54.
  • Halliday SJ, Casey JD, Rice TW, et al. Risk Factors for Cardiovascular Collapse during Tracheal Intubation of Critically III Adults. Ann Am Thorac Soc. 2020;17(8):1021–4.
  • Zuin M, Rigatelli G, Dell’Avvocata F, et al. Ketamine and midazolam differently impact post-intubation hemodynamic profile when used as induction agents during emergency airway management in hemodynamically stable patients with ST elevation myocardial infarction. Heart Vessels. 2018;33(3):213–25.
  • Dubée V, Hariri G, Joffre J, et al. Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability. Ann Intensive Care. 2022;12(1):68.
  • Smischney NJ, Kashyap R, Khanna AK, et al. Risk factors for and prediction of post-intubation hypotension in critically ill adults: A multicenter prospective cohort study. PLoS One. 2020;15(8):e0233852.
  • Allgöwer M, Burri C. "Schockindex" ["Shock index"]. Dtsch Med Wochenschr. 1967;92(43):1947-50.
  • Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: The Framingham heart study. Circulation. 2003;107(23):2920–5.
  • Fleck A, Hawker F, Wallace PI, et al. Increased Vascular Permeability: a Major Cause of Hypoalbuminaemia in Disease and Injury. Lancet. 1985;325(8432):781–4.
  • Starling EH. On the Absorption of Fluids from the Connective Tissue Spaces. J Physiol. 1896;19(4):312–26.
  • Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - J Am Med Assoc. 2016;315(8):801–10.
There are 21 citations in total.

Details

Primary Language English
Subjects Intensive Care
Journal Section ORIGINAL ARTICLE
Authors

Ömer Emgin 0000-0001-5607-0858

Bişar Ergün 0000-0003-4828-7576

Publication Date May 29, 2024
Acceptance Date February 20, 2024
Published in Issue Year 2024 Volume: 29 Issue: 2

Cite

Vancouver Emgin Ö, Ergün B. Risk factors of peri-intubation cardiovascular collapse in critically ill patients. Anatolian Clin. 2024;29(2):110-9.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.