P045: Impact of post-intubation hypotension on mortality of patients in the emergency department (ED)

Abstract

Introduction: Endotracheal intubation is frequently used in emergency departments and is often life saving, but it is also known to cause adverse events that can potentially lead to death. The main objective of this study is to evaluate mortality rates and duration of hospitalisation in patients who experienced post-intubation hypotension (PIH). Methods: A historical cohort of patients admitted between 07/2011 and 11/2014 at the ED of a level-one trauma centre. Patients were included if they were aged 16 years old or more, were intubated in the resuscitation room,had less than 3 intubation attempts, no need of surgical airway access, and had recorded vital signs prior to intubation. All clinical data including vitals were prospectively collected using ReaScribe®. PIH was defined by one measure or more of systolic arterial blood pressure <90 mm Hg. We retrospectively analysed the occurrence of PIH at 4 time points : 5, 15, 30 minutes, and at any moments after intubation. Study outcomes were in-hospital death and hospital length of stay in days (LOS). Univariate and multivariate analyses assessed the relation between PHI and outcomes. Results: 261 patients were included in the analyses. Amongst patient who experienced PIH, incidence of mortality was, respectively for each time estimate, of 31,0%, 33,3%, 28,6% and 26,9 % compared to 25,4% (p=0,5), 24,2% (p=0,1), 24,9% (p=0,5), and 25,4 % (p=0,8) in the normotensive group. The mean duration of hospitalisation in the group exposed to PIH was respectively of 26 (12,9-53,3), 22 (13,5-35,5), 19 (13,6-27,8), and 18 days (13.5-24.8) compared to 15,6 (12,9-18,9), 15,4 (12,6-18,8), 15,3 (12,3-19,1), and 15,5 (12.1-19.7) days (p=0,4). Conclusion: There was no association between the presence of post-intubation hypotension at 4 different time estimates and the in-hospital mortality nor the hospital length of stay. Further evaluation in specific sub-group should be foreseen to prevent adverse events from endotracheal intubation.