title: Postintubation hypotension in intensive care unit patients: A multicenter cohort study.
abstract: OBJECTIVE
  To determine the incidence of postintubation hypotension (PIH) and associated outcomes in critically ill patients requiring endotracheal intubation.
  
  
  METHODS
  Medical records were reviewed for 479 consecutive critically ill adult patients who required intubation by an intensive care unit (ICU) service at 1 of 4 academic tertiary care hospitals. The primary outcome measure was the incidence of PIH. Secondary outcome measures included mortality, ICU length of stay, requirement for renal replacement therapy, and a composite end point consisting of overall mortality, ICU length of stay greater than 14 days, duration of mechanical ventilation longer than 7 days, and renal replacement therapy requirement.
  
  
  RESULTS
  Overall, the incidence of PIH among ICU patients requiring intubation was 46% (218/479 patients). On univariate analysis, patients who developed PIH had increased ICU mortality (37% PIH vs 28% no PIH, P = .049) and overall mortality (39% PIH vs 30% no PIH, P = .045). After adjusting for important risk factors, development of PIH was associated with the composite end point of major morbidity and mortality (odds ratio, 2.00; 95% confidence interval, 1.30-3.07; P = .0017).
  
  
  CONCLUSIONS
  The development of PIH is common in ICU patients requiring emergency airway control and is associated with poor patient outcomes.
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Trauma Nova Scotia, Halifax, Nova Scotia, Canada. Electronic address: greenrs@dal.ca.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Green
authors.affiliation: CHU de Québec Research Center, Hôpital de L'Enfant-Jésus, Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine Group), Université Laval, Québec City, Québec, Canada; Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada. Electronic address: alexis.turgeon@fmed.ulaval.ca.
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: lmcintyre@ohri.ca.
authors.forename: Lauralyn A
authors.initials: LA
authors.lastname: McIntyre
authors.affiliation: Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, David Braley Research Institute, Hamilton, Ontario, Canada. Electronic address: afoxrob@mcmaster.ca.
authors.forename: Alison E
authors.initials: AE
authors.lastname: Fox-Robichaud
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, Division of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: dafergusson@ohri.ca.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.affiliation: Department of Community Health and Epidemiology (Capital Health, Dalhousie University, IWK Health Centre), Centre for Clinical Research, Halifax, Nova Scotia, Canada. Electronic address: Steve.Doucette@nshealth.ca.
authors.forename: Steve
authors.initials: S
authors.lastname: Doucette
authors.affiliation: Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: mbbutler@dal.ca.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Butler
authors.affiliation: Trauma Nova Scotia, Halifax, Nova Scotia, Canada. Electronic address: mete.erdogan@nshealth.ca.
authors.forename: Mete
authors.initials: M
authors.lastname: Erdogan
mesh_terms: D058109:Airway Management / Q000379:methods; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Airway management; Hemodynamics; Intensive care units; Intratracheal; Intubation; Multicenter study