title: Post-medication Hypotension after Administration of Sedatives and Opioids during Critical Care Transport.
abstract: OBJECTIVE
  Identification of modifiable risk factors for hypotension during critical care transport is important to optimize patient preparation, crew training, and patient safety. We set out to determine the incidence of hemodynamic deterioration after administration of opioids or sedatives during critical care transport, and identify patient- and transport-level predictors.
  
  
  METHODS
  We assembled a retrospective cohort of adults undergoing urgent critical care transport between January 1, 2005, and December 31, 2010. The primary outcome was post-medication hypotension, defined by new hypotension or new vasopressor within 10 minutes of medication administration.
  
  
  RESULTS
  Opioids or sedatives were administered 28,592 times in 8,328 patient transports, with 159 episodes of post-medication hypotension (0.6% of all medication administrations). Mechanical ventilation (adjusted odds ratio [OR] 4.9; 95% confidence interval [95%CI] 2.7-8.9), baseline vasopressor requirement (adjusted OR 2.1; 95%CI 1.3-3.4), transport duration (adjusted OR 1.5; 95%CI 1.1-2.2) per log unit increment of duration), surgical diagnosis (adjusted OR 4.1; 95%CI 1.6-10.7 compared to trauma), and ACP crew level (adjusted OR 2.4 compared to baseline of CCP; 95%CI 1.5-3.8) were all associated with an increased odds of post-medication hypotension. ACP crew level remained associated with increased post-medication hypotension in a sensitivity analysis of 1,242 propensity-matched pairs (crude OR for ACP vs. CCP 3.0; 95%CI 1.4-6.5).
  
  
  CONCLUSIONS
  Post-medication hypotension occurred once in every 160 drug administrations and was associated with mechanical ventilation, baseline hemodynamic instability, transport duration, surgical diagnosis, and ACP crew. These findings provide targets for improvements in patient preparation, crew training, and clinical practices.
authors: Jeffrey M
authors: JM
authors: Singh
authors: Russell D
authors: RD
authors: MacDonald
authors: Mahvareh
authors: M
authors: Ahghari
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007022:Hypotension / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014187:Transportation of Patients / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
keywords: adverse event; critical event; patient safety; patient transport