title: Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill.
abstract: BACKGROUND
  We aim to report the incidence of post-intubation hypotension in the critically ill, to report in-hospital mortality and length of stay in those who developed post-intubation hypotension, and to explore possible risk factors associated with post-intubation hypotension.
  
  
  METHODS
  Adult (≥18 years) ICU patients who received emergent endotracheal intubation were included. We excluded patients if they were hemodynamically unstable 60 minutes pre-intubation. Post-intubation hypotension was defined as the administration of any vasopressor within 60 minutes following intubation.
  
  
  RESULTS
  Twenty-nine patients developed post-intubation hypotension (29/147, 20%). Post-intubation hypotension was associated with increased in-hospital mortality (11/29, 38% vs. 19/118, 16%) and length of stay (21 [10-37] vs. 12 [7-21] days) on multivariate analysis. Three risk factors for post-intubation hypotension were identified on multivariate analysis: 1) decreasing mean arterial pressure pre-intubation (per 5 mmHg decrease) (p-value=0.04; 95% CI 1.01-1.55); 2) administration of neuromuscular blockers (p-value=0.03; 95% CI 1.12-6.53); and 3) intubation complication (p-value=0.03; 95% CI 1.16-15.57).
  
  
  CONCLUSIONS
  Post-intubation hypotension was common in the ICU and was associated with increased in-hospital mortality and length of stay. These patients were more likely to have had lower mean arterial pressure prior to intubation, received neuromuscular blockers, or suffered a complication during intubation.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Smischney
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Demirci
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Diedrich
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Barbara
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Sandefur
authors.affiliation: Department of Pediatric Critical Care, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sangita
authors.initials: S
authors.lastname: Trivedi
authors.affiliation: Department of Anesthesiology, Boise Anesthesia, PA, Saint Alphonsus Boise, Boise, ID, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: McGarry
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
mesh_terms: D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012720:Severity of Illness Index
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