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Physiopathologie et prise en charge de l’hypotension post-intubation en séquence rapide

Pathophysiology and management of rapid sequence intubation induced hypotension

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Annales françaises de médecine d'urgence

Résumé

Une hypotension artérielle à la suite d’une intubation en séquence rapide est fréquente. Cette hypotension, encore appelée en France collapsus de reventilation, est multifactorielle. Après analyse de la fréquence et de la morbimortalité de l’hypotension post-intubation (HPI), les mécanismes physiopathologiques ainsi que les différents paramètres aboutissant à cette hypotension sont décrits. Les différents facteurs prédictifs d’HPI sont analysés afin de proposer une conduite à tenir, tant sur le plan préventif que curatif. Ainsi, le remplissage vasculaire systématique avant toute intubation en urgence, le choix des agents utilisés pour l’induction puis pour l’entretien de la sédation, les réglages des paramètres ventilatoires (notions de ventilation protectrice et d’hypercapnie permissive) et enfin le recours aux amines vasopressives sont autant de moyens efficaces pour lutter contre l’HPI.

Abstract

Arterial hypotension frequently occurs following a rapid sequence of intubation. This hypotension is multifactorial. After analyzing the frequency of morbidity and mortality of post-intubation hypotension (HPI), our purpose was to describe the physiopathologic mechanisms as well as the different parameters leading to hypotension. We also analyzed the various predictive factors of HPI to propose both preventive and curative management. Indeed, systematic vascular loading before intubation, the choice of drugs used for induction and maintenance of sedation, the settings of the ventilatory parameters (protective ventilation and permissive hypercapnia) and finally the use of vasopressor amines are all effective ways to efficiently treat HPI.

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Références

  1. Vivien B, Adnet F, Bounes V, et al (2011) Recommandations formalisées d’experts 2010: sédation et analgésie en structure d’urgence (réactualisation de la conférence d’experts de la SFAR de 1999). Ann Fr Med Urgence 1:57–71

    Article  Google Scholar 

  2. Adnet F, De La Coussaye JE, Jabre P (2010) Intubation en séquence rapide: quels médicaments utiliser en préhospitalier? Réanimation 19:622–6

    Article  Google Scholar 

  3. Franklin C, Samuel J, Hu TC (1994) Life-threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. Am J Emerg Med 12:425–8

    Article  CAS  PubMed  Google Scholar 

  4. Schwartz DE, Matthay MA, Cohen NA (1995) Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 82:367–73

    Article  CAS  PubMed  Google Scholar 

  5. Jabre P, Galinski M, Ricard-Hibon A, et al (2011) Out-of-Hosptal tracheal intubation with single-use versus reusable metal laryngoscope blades: a multicentre randomized controlled trial. Am J Emerg Med 57: 225–31

    Article  Google Scholar 

  6. Le Tacon S, Wolter P, Rusterholtz T, et al (2000) Complications of difficult tracheal intubations in a critical care unit. Ann Fr Anesth Réanim 19:719–24

    Article  PubMed  Google Scholar 

  7. Griesdale DE, Bosma TL, Kurth T, et al (2008) Complications of endotracheal intubation in the critically ill. Intensive Care Med 34:1835–42

    Article  PubMed  Google Scholar 

  8. Jaber S, Amraoui J, Lefrant JY, et al (2006) Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 34:2355–61

    Article  PubMed  Google Scholar 

  9. Heffner AC, Huang DT, Al-Khafaji A (2007) Post-intubation hypotension during emergency airway management. Chest 132:664c–665c

    Article  Google Scholar 

  10. Green R, Hutton B, McIntyre L, et al (2009) Incidence of postintubation hemodynamic instability associated with emergent endotracheal intubations: a systematic review. Crit Care 13:P14

    Article  PubMed Central  Google Scholar 

  11. Griesdale DE, Henderson WR, Green RS (2011) Airway Management in critically ill patients. Lung 189:181–92

    Article  PubMed  Google Scholar 

  12. Heffner AC, Swords D, Kline JA, et al (2012) The frequency and signifiance of post-intubation hypotension during emergency airway management. J Crit Care 27:417.e9–13

    Google Scholar 

  13. Mort TC (2007) Complications of emergency tracheal intubation: hemodynamic alterations. J Intensive Care Med 22:157–65

    Article  PubMed  Google Scholar 

  14. Dunham CM, Barraco RD, Clark DE, et al (2003) EAST Practice Management Guidelines Work Group. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma 55:162–79

    Article  PubMed  Google Scholar 

  15. Reich DL, Hossain S, Krol M, et al (2005) Predictors of hypotension after induction of general anesthesia. Anesth Analg 101:622–8

    Article  PubMed  Google Scholar 

  16. Smischney NJ, Demirci O, Diedrich DA, et al (2016) Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill. Med Sci Monit 22:346–55

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smischney NJ, Demirci O, Ricter BD, et al (2015) Vasopressor use as a surrogate for post-intubation hemodynamic instability is associated with in-hospital and 90-day mortality: a retrospective cohort study. BMC Res Notes 8:445

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schwab TM, Greaves TH (1998) Cardiac arrest as a possible sequela of critical airway management and intubation. Am J Emerg Med 16:609–12

    Article  CAS  PubMed  Google Scholar 

  19. Pourriat JL, Martin C (2005) Principes de réanimation chirurgicale. Arnette pp 654–5

    Google Scholar 

  20. Gudzenko V, Bittner EA, Schmidt UH (2010) Emergency airway management. Respir Care 55:1026–35

    PubMed  Google Scholar 

  21. Reynolds SF, Heffner J (2005) Airway management of the critically ill patient. Chest 127:1397–412

    PubMed  Google Scholar 

  22. Zed PJ, Abu-Laban RB, Harrison DW (2006) Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: an observational cohort study. Acad Emerg Med 13:378–83

    Article  PubMed  Google Scholar 

  23. Jabre P, Combes X, Lapostolle F, et al (2009) Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 374: 293–300

    Article  CAS  PubMed  Google Scholar 

  24. Mohammad Z, Afessa B, Finkielman JD (2006) The incidence of relative adrenal insufficiency in patients with septic shock after the administration of etomidate. Crit Care 10:R105

    Article  PubMed  PubMed Central  Google Scholar 

  25. Den Brinker M, Hokken-Koelega AC, Hazelzet JA, et al (2008) One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis. Intensive Care Med 34:163–8

    Article  CAS  PubMed  Google Scholar 

  26. Allolio B, Dorr H, Stuttmann R, et al (1985) Effect of a single bolus of etomidate upon eight major corticosteroid hormones and plasma ACTH. Clin Endocrinol 22:81–286

    Article  Google Scholar 

  27. Ray DC, McKeown DW (2007) Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock. Crit Care 11:R56

    Article  PubMed  PubMed Central  Google Scholar 

  28. Riche FC, Boutron CM, Valleur P, et al (2007) Adrenal response in patients with septic shock of abdominal origin: relationship to survival. Intensive Care Med 33:1761–6

    Article  PubMed  Google Scholar 

  29. Davis DP, Kimbro TA, Vilke GM (2001) The use of midazolam for prehospital rapid-sequence intubation may be associated with a dose-related increase in hypotension. Prehosp Emerg Care 5:163–8

    Article  CAS  PubMed  Google Scholar 

  30. Choi YF, Wong TW, Lau CC (2004) Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation. Emerg Med J 21:700–2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Alexander R, Olufolabi AJ, Booth J, et al (1999) Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia 54:1037–40

    Article  CAS  PubMed  Google Scholar 

  32. Erhan E, Ugur G, Gunusen I, et al (2003) Propofol–not thiopental or etomidate–with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade. Can J Anaesth 50:108–15

    Article  PubMed  Google Scholar 

  33. Larsen R, Rathgeber J, Bagdahn A, et al (1988) Effects of propofol on cardiovascular dynamics and coronary blood flow in geriatric patients: a comparison with etomidate. Anaesthesia 43:25–31

    Article  PubMed  Google Scholar 

  34. VanAken H, Meinshausen E, Prien T, et al (1988) The influence of fentanyl and tracheal intubation on the hemodynamic effects of anesthesia induction with propofol/N2O in humans. Anesthesiology 68:157–63

    Article  CAS  Google Scholar 

  35. L’Hommedieu CS, Arens JJ (1987) The use of ketamine for the emergency intubation of patients with status asthmaticus. Ann Emerg Med 16:568–71

    Article  PubMed  Google Scholar 

  36. Takeshita H, Okuda Y, Sari A (1972) The effects of ketamine on cerebral circulation and metabolism in man. Anesthesiology 36:69–75

    Article  CAS  PubMed  Google Scholar 

  37. Shaprio HM, Wyte SR, Harris AB (1972) Ketamine anaesthesia in patients with intracranial pathology. Br J Anaesth 44:1200–4

    Article  CAS  PubMed  Google Scholar 

  38. Sehdev RS, Symmons DA, Kindl K (2006) Ketamine for rapid sequence induction in patients with head injury in the emergency department. Emerg Med Australas 18:37–44

    Article  PubMed  Google Scholar 

  39. Albanese J, Arnaud S, Rey M, et al (1997) Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology 87:1328–34

    Article  CAS  PubMed  Google Scholar 

  40. Bourgoin A, Albanese J, Wereszczynski N, et al (2003) Safety of sedation with ketamine in severe head injury patients: comparison with sufentanil. Crit Care Med 31:711–7

    Article  CAS  PubMed  Google Scholar 

  41. Kierzek G, Pourriat JL (2005) Sédation en réanimation de l’adulte. EMC Anesthésie Réanimation 2:185–203

    Article  Google Scholar 

  42. Manthous CA (2010) Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. J Emerg Med 38:622–31

    Article  PubMed  Google Scholar 

  43. Teboul JL, Graini L, Mercat A, et al (1995) Retentissement hémodynamique de l’assistance ventilatoire. Reanim Urg 4:129–38

    Article  Google Scholar 

  44. Lin CC, Chen KF, Shih CP, et al (2008) The prognostic factors of hypotension after rapid sequence intubation. Am J Emerg Med 26:845–51

    Article  PubMed  Google Scholar 

  45. Dufour DG, Larose DL, Clement SC (1995) Rapid sequence intubation in the emergency department. J Emerg Med 13:705–10

    Article  CAS  PubMed  Google Scholar 

  46. Goldwasser P, Feldman J (1997) Association of serum albumin and mortality risk. J Clin Epidemiol 50:693–703

    Article  CAS  PubMed  Google Scholar 

  47. Hasegawa K, Hagiwara Y, Imamura T, et al (2013). Increased incidence of hypotension in elderly patients who underwent emergency airway management: an analysis of a multi-centre prospective observational study. Int J Emerg Med 6:12

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kim WY, Kwak MK, Ko BS, et al (2014). Factors associated with the occurrence of cardiac arrest after emergency tracheal intubation in the emergency department. PLoS ONE 9:e112779

    Article  PubMed  PubMed Central  Google Scholar 

  49. Charpentier J, Luyt CE, Fulla Y, et al (2004) Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med 32:660–5

    Article  CAS  PubMed  Google Scholar 

  50. Ognibene FP, Parker MM, Natanson C, et al (1988) Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest 93:903–10

    Article  CAS  PubMed  Google Scholar 

  51. Jaber S, Jung B, Corne P, et al (2010) An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med 36:248–55

    Article  PubMed  Google Scholar 

  52. Walz JM, Zayaruzny M, Heard SO (2007) Airway management in critical illness. Chest 131:608–20

    Article  PubMed  Google Scholar 

  53. Jung B, Chanques G, Sebbane M, et al (2008) Les modalités de l’intubation en urgence et ses complications. Réanimation 17:753–60

    Article  Google Scholar 

  54. Mirakhur RK (2009) Sugammadex in clinical practice. Anaesthesia 64(Suppl.1):45–54

    Article  CAS  PubMed  Google Scholar 

  55. Leone M, Michel F, Martin C (2008) Sympathomimétiques: pharmacologie et indications thérapeutiques en réanimation. EMC Anesthésie-Réanimation 236-365-A-10

    Google Scholar 

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Authors and Affiliations

  1. Pôle anesthésie réanimation douleur urgences, CHU de Nîmes, F-30029, Nîmes, France

    J. Treille, J. E. de La Coussaye & P. -G. Claret

  2. Pôle réanimation urgences SAMU hyperbarie, Assistance Publique des Hôpitaux de Marseille, F-13010, Marseille, France

    J. Bessereau & P. Michelet

  3. Pôle urgences réanimation médicale et chirurgicale anesthésie, groupement hospitalier sud, hospices civils de Lyon, F-69365, Lyon, France

    M. Douplat

  4. Aix-Marseille université, UMR 7268 ADES, F-13005, Marseille, France

    M. Douplat

  5. Département d’anesthésie, polyclinique du Grand Sud, F-30900, Nîmes, France

    J. M. Treille

  6. Aix-Marseille université, UMR D2, F-13005, Marseille, France

    P. Michelet

  7. UFR Médecine Montpellier-Nîmes, 2 rue École de Médecine, université de Montpellier, F-34060, Montpellier, France

    J. E. de La Coussaye

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  1. J. Treille
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  2. J. Bessereau
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  3. M. Douplat
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  4. J. M. Treille
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  6. J. E. de La Coussaye
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  7. P. -G. Claret
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Correspondence to J. Treille.

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Treille, J., Bessereau, J., Douplat, M. et al. Physiopathologie et prise en charge de l’hypotension post-intubation en séquence rapide. Ann. Fr. Med. Urgence 7, 239–246 (2017). https://doi.org/10.1007/s13341-017-0756-y

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  • DOI: https://doi.org/10.1007/s13341-017-0756-y

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