PIH in Trauma
Development of postintubation hypotension (PIH) in critically ill patients in the ED and ICU settings is known to be associated with increased morbidity and mortality. It is unclear whether the same is true in the trauma population. To address this, we performed a retrospective analysis of major trauma patients requiring intubation in Nova Scotia.
Data on all adult trauma patients who required endotracheal intubation by the TNS Trauma Service at the QEII Health Sciences Centre in Halifax was collected from the Nova Scotia Trauma Registry between 2000 and 2015. Our primary outcome of interest was the prevalence of PIH. As secondary outcomes, we evaluated mortality (in-hospital, emergency department, admission to hospital or the ICU, length of stay (in-hospital, ICU, and requirement for renal replacement therapy, mechanical ventilation, or therapy with vasopressor medications as an in-patient. Using multivariate logistic regressions, we controlled for patient and provider characteristics, and we tested for association between PIH development and patient outcomes. The findings of the study are summarized in the infographic.
Development of PIH was common (36.3%) among intubated major trauma patients at our institution. Furthermore, PIH was associated with increased ED mortality and in-hospital mortality in these patients. These findings suggest that there may be potentially important patient safety issues related to the practice of endotracheal intubation in this population.
This study has been accepted for publication in the Journal of Trauma and Acute Care Surgery. (PubMed)
Posted July 14, 2017