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The impact of post-intubation hypotension on length of stay and mortality in adult and geriatric patients: a cohort study

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Abstract

Objective

To evaluate the association between standard post-intubation hypotension (< 90 mmHg) and in-hospital mortality. Secondary objectives were to evaluate the association of post-intubation hypotension and length of stay and to assess the impact of increasing post-intubation hypotension threshold to 110 mmHg on hospital length of stay and 48 h-mortality in patients aged ≥ 65 years.

Methods

Design and setting: A cohort of patients admitted in a level-1 trauma centre emergency department (ED) between November 2011 and July 2016. Inclusion criteria: aged ≥ 16 with available pre-intubation vital signs, intubation performed in ≤ 3 attempts with no surgical access needed. Measures: Prospective electronic data collection was used for clinical data. Main outcome: 48-h in-hospital mortality. Secondary outcome: hospital length of stay. Analyses: Univariate and multivariate analyses.

Results

A total of 586 patients were included. The mean age was 56.3 ± 18.8 years and 37% were aged ≥ 65 years. Within 60 min of intubation, 224 (38%) patients had at least one systolic blood pressure measure < 90 mmHg and 164(28%) had at least two measures. The < 110 mmHg threshold showed a total of 377 patients (64%) had at least one systolic blood pressure measure < 110 mmHg and 286 (49%) had at least two measures. We found no significant difference in the risk of mortality overall and in stratified-age groups and no association with increased hospital length of stay using both post-intubation hypotension thresholds.

Conclusion

Post-intubation hypotension was recorded in one out of three patients in the ED but we found no association between post-intubation hypotension and 48-h in-hospital mortality overall in adults or geriatric patients.

Résumé

Objectif

Évaluer l'association entre l'hypotension post-intubation selon le seuil standard (< 90 mmHg) et la mortalité hospitalière. Les objectifs secondaires étaient d'évaluer l'association entre l'hypotension post-intubation et la durée de séjour et d'évaluer l'impact d'augmenter le seuil d'hypotension post-intubation à 110 mmHg sur la durée de séjour à l'hôpital et la mortalité à 48 heures chez les patients âgés de ≥ 65 ans.

Méthodes

Devis et contexte: Une cohorte de patients admis au département d'urgence d'un centre de traumatologie de niveau 1 entre 06/2011 et 05/2016. Critères d'inclusion: âge ≥ 16 ans avec signes vitaux pré-intubation disponibles, intubation réalisée en ≤ 3 tentatives sans accès chirurgical. Mesures: Les données cliniques ont été colligées électroniquement de façon prospective. Issue primaire: Mortalité hospitalière à 48 heures. Issue secondaire: durée du séjour à l'hôpital. Analyses: Analyses univariées et multivariées.

Résultats

Un total de 586 patients ont été inclus. L'âge moyen était de 56,3 ± 18,8 ans et 37% étaient âgés de ≥ 65 ans. Dans les 60 min suivant l'intubation, 224 (38%) patients avaient au moins une mesure de tension artérielle systolique < 90 mmHg et 164 (28%) avaient au moins deux mesures. Avec le seuil de < 110 mmHg, un total de 377 patients (64%) avaient au moins une mesure de tension artérielle systolique < 110 mmHg et 286 (49%) en avaient au moins deux. Nous n’avons constaté aucune différence significative dans le risque de mortalité dans l’ensemble et dans différentes strates d'âge, et aucun lien avec l’augmentation de la durée du séjour à l’hôpital en utilisant les deux seuils d'hypotension post-intubation.

Conclusion

L'hypotension post-intubation a été enregistrée chez un patient sur trois au département d'urgences mais nous n'avons trouvé aucune association entre l'hypotension post-intubation et la mortalité hospitalière à 48 heures, que ce soit dans une population adulte ou chez les patients âgés.

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Funding

This project was funded by the Université Laval and the Fondation du CHU de Québec-Université Laval. Those sponsors played no role in the design or conduct of this study.

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Authors and Affiliations

  1. CHU de Québec-Université Laval Research Centre, 18e rue, 1401, H-608, Quebec, QC, G1J 1Z4, Canada

    Marcel Émond, Valérie Boucher, Jean-Nicolas Tourigny & Natalie Le Sage

  2. VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, QC, Canada

    Marcel Émond, Valérie Boucher, Jean-Nicolas Tourigny & Natalie Le Sage

  3. Département de médecine familiale et de médecine d’urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada

    Marcel Émond, David Lachance-Perreault, Jeanne Turgeon, Alexandra Akoum, Jean-Nicolas Tourigny & Natalie Le Sage

  4. Centre d’excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec, QC, Canada

    Marcel Émond, Valérie Boucher & Pierre-Hugues Carmichael

  5. Département de médecine familiale et médecine d’urgence, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Audrey-Anne Brousseau

Authors
  1. Marcel Émond
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  2. David Lachance-Perreault
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  3. Valérie Boucher
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  4. Pierre-Hugues Carmichael
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  5. Jeanne Turgeon
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  6. Audrey-Anne Brousseau
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  7. Alexandra Akoum
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  8. Jean-Nicolas Tourigny
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  9. Natalie Le Sage
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Corresponding author

Correspondence to Marcel Émond.

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Conflict of interest

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Ethics approval

This project was approved by the CHU de Québec-Université Laval Research Ethics Board (#2012–1659).

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Émond, M., Lachance-Perreault, D., Boucher, V. et al. The impact of post-intubation hypotension on length of stay and mortality in adult and geriatric patients: a cohort study. Can J Emerg Med 24, 509–514 (2022). https://doi.org/10.1007/s43678-022-00305-0

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  • DOI: https://doi.org/10.1007/s43678-022-00305-0

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