Prophylactic Administration of Vasopressors Prior to Emergency Intubation in Critically Ill Patients: A Secondary Analysis of Two Multicenter Clinical Trials.

Autor: Fuchita M; Department of Anesthesiology, Division of Critical Care, University of Colorado Anschutz Medical Campus, Aurora, CO., Pattee J; Department of Biostatistics & Informatics, Center for Innovative Design & Analysis, Colorado School of Public Health, Aurora, CO., Russell DW; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.; Pulmonary Section, Birmingham Veterans Affairs Medical Center, Birmingham, AL., Driver BE; Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN., Prekker ME; Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN., Barnes CR; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA., Brewer JM; Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS., Doerschug KC; Department of Internal Medicine, University of Iowa, Iowa City, IA., Gaillard JP; Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC.; Department of Anesthesiology, Section on Critical Care, Wake Forest School of Medicine, Winston-Salem, NC., Gandotra S; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL., Ghamande S; Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Baylor Scott & White Medical Center, Temple, TX., Gibbs KW; Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest School of Medicine, Winston-Salem, NC., Hughes CG; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN., Janz DR; University Medical Center New Orleans, New Orleans, LA.; Department of Medicine, Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, LA., Khan A; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University School of Medicine, Portland, OR., Mitchell SH; Department of Emergency Medicine, University of Washington, Seattle, WA., Page DB; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL., Rice TW; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN., Self WH; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN., Smith LM; Department of Internal Medicine, University of Iowa, Iowa City, IA., Stempek SB; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA., Trent SA; Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.; Department of Emergency Medicine, Denver Health Medical Center, Denver, CO., Vonderhaar DJ; Department of Pulmonary and Critical Care Medicine, Ochsner Health System, New Orleans, LA., West JR; Department of Emergency Medicine, NYC Health + Hospitals | Lincoln, Bronx, NY., Whitson MR; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL., Williamson K; Department of Biostatistics & Informatics, Center for Innovative Design & Analysis, Colorado School of Public Health, Aurora, CO., Semler MW; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN., Casey JD; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN., Ginde AA; Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Jazyk: angličtina
Zdroj: Critical care explorations [Crit Care Explor] 2023 Jul 12; Vol. 5 (7), pp. e0946. Date of Electronic Publication: 2023 Jul 12 (Print Publication: 2023).
DOI: 10.1097/CCE.0000000000000946
Abstrakt: Hypotension affects approximately 40% of critically ill patients undergoing emergency intubation and is associated with an increased risk of death. The objective of this study was to examine the association between prophylactic vasopressor administration and the incidence of peri-intubation hypotension and other clinical outcomes.
Design: A secondary analysis of two multicenter randomized clinical trials. The clinical effect of prophylactic vasopressor administration was estimated using a one-to-one propensity-matched cohort of patients with and without prophylactic vasopressors.
Setting: Seven emergency departments and 17 ICUs across the United States.
Patients: One thousand seven hundred ninety-eight critically ill patients who underwent emergency intubation at the study sites between February 1, 2019, and May 24, 2021.
Interventions: None.
Measurements and Main Results: The primary outcome was peri-intubation hypotension defined as a systolic blood pressure less than 90 mm Hg occurring between induction and 2 minutes after tracheal intubation. A total of 187 patients (10%) received prophylactic vasopressors prior to intubation. Compared with patients who did not receive prophylactic vasopressors, those who did were older, had higher Acute Physiology and Chronic Health Evaluation II scores, were more likely to have a diagnosis of sepsis, had lower pre-induction systolic blood pressures, and were more likely to be on continuous vasopressor infusions prior to intubation. In our propensity-matched cohort, prophylactic vasopressor administration was not associated with reduced risk of peri-intubation hypotension (41% vs 32%; p = 0.08) or change in systolic blood pressure from baseline (-12 vs -11 mm Hg; p = 0.66).
Conclusions: The administration of prophylactic vasopressors was not associated with a lower incidence of peri-intubation hypotension in our propensity-matched analysis. To address potential residual confounding, randomized clinical trials should examine the effect of prophylactic vasopressor administration on peri-intubation outcomes.
Competing Interests: Dr. Fuchita received a departmental seed grant from the University of Colorado, Department of Anesthesiology, for biostatistical support. Dr. Casey was supported in part by the National Institutes of Health (NIH) (K23HL153584). Dr. Semler was supported in part by the NIH (K23HL143053). The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze: MEDLINE
Externí odkaz: