Identifying & Preventing Post-Intubation Hypotension by Dr. Michael Coletta

Identifying and preventing Post-Intubation; Part I: Identifying the patient at risk

  • Intubating patient who are sick, hypoxic, and need definitive airway management is inevitable and the stakes for this intubation are higher than normal.
  • About 25% of patients intubated in the ED experience some form of post-intubation hypotension (PIH) while as many as 3% of which will experience cardiac arrest.
  • PIH has been shown to increase mortality, ICU length of stay, and increased risk of in-hospital cardiac arrest!
  • To better prepare for these intubations, we must predict which patients are at an increased risk for PIH, these include:
    • patients with an elevated shock index (HR/SBP) ≥ 0.8
    • elderly patients (less cardiopulmonary reserve)
    • patients with intravascular volume depletion
  • Next week, part II will discuss how we should prepare and deal with PIH when it occurs.