Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.
BACKGROUND
In many hospitals, emergency physicians commonly initiate invasive positive-pressure ventilation.


OBJECTIVE
To review common patient- and ventilator-related factors that can promote hemodynamic instability during and after endotracheal intubation.


CONCLUSIONS
Venous return is proportional to mean systemic pressure (Pms) minus right atrial pressure (Pra). Endotracheal intubation with positive-pressure ventilation often reduces Pms while always increasing Pra, so venous return inevitably decreases, resulting in hypotension in almost one-third of patients. This article reviews the pathophysiology of respiratory failure, the basic circulatory physiology associated with endotracheal intubation, and methods that may be helpful to reduce the frequency of intubation-related hypotension.


CONCLUSIONS
Although unproven, preventive measures taken before, during, and after endotracheal intubation are likely to minimize the frequency, magnitude, and duration of intubation-related hypotension.
Manthous
Constantine A
CA
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
D004636:Emergency Service, Hospital; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy