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

Yıl 2024, Cilt: 29 Sayı: 2, 110 - 119, 29.05.2024

Ömer Emgin Bişar Ergün

https://doi.org/10.21673/anadoluklin.1310223

Öz

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.

Anahtar Kelimeler

Airway management, cardiovascular collapse, intensive care unit, intubation, mortality, shock index

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

Öz

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.

Anahtar Kelimeler

Endotrakeal entübasyon, hava yolu yönetimi, kardiyovasküler kollaps, mortalite, şok indeks, yoğun bakım ünitesi

Kaynakça

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