title: Risk factors for hypotension in urgently intubated burn patients.
abstract: BACKGROUND
  When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability.
  
  
  METHODS
  A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality.
  
  
  RESULTS
  Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n=168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004-1.027, p<0.001) and presumed sepsis (OR 1.852, 95% CI 1.100-3.117, p=0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis.
  
  
  CONCLUSIONS
  In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors.
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dennis
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.forename: Seth R
authors.initials: SR
authors.lastname: Holland
authors.forename: Brian S
authors.initials: BS
authors.lastname: Yoon
authors.forename: Daun J
authors.initials: DJ
authors.lastname: Milligan
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Nitzschke
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Maani
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Hansen
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
mesh_terms: D000328:Adult; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003422:Critical Care / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007022:Hypotension / Q000209:etiology*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D006993:Hypnotics and Sedatives; D014662:Vasoconstrictor Agents