Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan.
Faculty of Medicine, Graduate School of Medicine, Kagawa University, Miki, Kita, Kagawa, Japan.
PLoS One. 2019 Feb 11;14(2):e0212170. doi: 10.1371/journal.pone.0212170. eCollection 2019.
Studies in the non-emergency department (ED) settings have reported the relationships of post-intubation hypertension with poor patient outcomes. While ED-based studies have examined post-intubation hypotension and its sequelae, little is known about, post-intubation hypertension and its risk factors in the ED settings. In this context, we aimed to identify the incidence of post-intubation hypertension in the ED, and to test the hypothesis that repeated intubation attempts are associated with an increased risk of post-intubation hypertension.
This study is a secondary analysis of the data from a multicenter prospective observational study of emergency intubations in 15 EDs from 2012 through 2016. The analytic cohort comprised all adult non-cardiac-arrest patients undergoing orotracheal intubation without pre-intubation hypotension. The primary exposure was the repeated intubation attempts, defined as ≥2 laryngoscopic attempts. The outcome was post-intubation hypertension defined as an increase in systolic blood pressure (sBP) of >20% along with a post-intubation sBP of >160 mmHg. To investigate the association of repeated intubation attempts with the risk of post-intubation hypertension, we fit multivariable logistic regression models adjusting for ten potential confounders and patient clustering within the EDs.
Of 3,097 patients, the median age was 69 years, 1,977 (64.0%) were men, and 991 (32.0%) underwent repeated intubation attempts. Post-intubation hypertension was observed in 276 (8.9%). In the unadjusted model, the incidence of post-intubation hypertension did not differ between the patients with single intubation attempt and those with repeated attempts (8.5% versus 9.8%, unadjusted P = 0.24). By contrast, after adjusting for potential confounders and patient clustering in the random-effects model, the patients who underwent repeated intubation attempts had a significantly higher risk of post-intubation hypertension (OR, 1.56; 95% CI, 1.11-2.18; adjusted P = 0.01).
We found that 8.9% of patients developed post-intubation hypertension, and that repeated intubation attempts were significantly associated with a significantly higher risk of post-intubation hypertension in the ED.
非急诊部门（ED）的研究报告了插管后高血压与患者预后不良的关系。虽然 ED 基础研究已经检查了插管后低血压及其后果，但对于 ED 环境中插管后高血压及其危险因素知之甚少。在这种情况下，我们的目的是确定 ED 中插管后高血压的发生率，并检验重复插管尝试与插管后高血压风险增加相关的假设。
这是一项对 2012 年至 2016 年期间在 15 个 ED 进行的紧急插管多中心前瞻性观察研究数据的二次分析。分析队列包括所有非心搏骤停成人患者，这些患者在插管前没有低血压，进行经口气管插管。主要暴露是重复插管尝试，定义为≥2 次喉镜尝试。结果是插管后高血压，定义为收缩压（sBP）升高>20%，且插管后 sBP>160mmHg。为了研究重复插管尝试与插管后高血压风险的关系，我们在多变量逻辑回归模型中调整了 10 个潜在混杂因素和 ED 内患者聚类，并进行了调整。
在 3097 例患者中，中位年龄为 69 岁，1977 例（64.0%）为男性，991 例（32.0%）进行了重复插管尝试。观察到 276 例（8.9%）患者发生插管后高血压。在未调整模型中，单次插管尝试和重复插管尝试的患者插管后高血压的发生率无差异（8.5%与 9.8%，未调整 P=0.24）。相比之下，在随机效应模型中调整潜在混杂因素和患者聚类后，重复插管尝试的患者插管后高血压的风险显著更高（OR，1.56；95%CI，1.11-2.18；调整 P=0.01）。
我们发现 8.9%的患者发生插管后高血压，重复插管尝试与 ED 中插管后高血压的风险显著增加显著相关。
