Smischney Nathan J, Surani Salim R, Montgomery Ashley, Franco Pablo Moreno, Callahan Cynthia, Demiralp Gozde, Tedja Rudy, Lee Sarah, Kumar Santhi I, Khanna Ashish K
4352Mayo Clinic, Rochester, Minnesota.
Corpus Christi Medical Center, Corpus Christi, Texas Research Collaborator (limited tenure), Mayo Clinic, Rochester, Minnesota.
J Intensive Care Med. 2022 Nov;37(11):1467-1479. doi: 10.1177/08850666221085256. Epub 2022 Mar 4.
Hypotension with endotracheal intubation (ETI) is common and associated with adverse outcomes. We sought to evaluate whether a previously described hypotension prediction score (HYPS) for ETI is associated with worse patient outcomes and/or clinical conditions.
This study is a post hoc analysis of a prospective observational multicenter study involving adult (age ≥18 years) intensive care unit (ICU) patients undergoing ETI in which the HYPS was derived and validated on the entire cohort and a stable subset (ie, patients in stable condition). We evaluated the association between increasing HYPSs in both subsets and several patient-centered outcomes and clinical conditions.
Complete data for HYPS calculations were available for 783 of 934 patients (84%). Logistic regression analysis showed increasing odds ratios (ORs) for the highest risk category for new-onset acute kidney injury (OR, 7.37; 95% CI, 2.58-21.08); new dialysis need (OR, 8.13; 95% CI, 1.74-37.91); ICU mortality (OR, 16.39; 95% CI, 5.99-44.87); and hospital mortality (OR, 18.65; 95% CI, 6.81-51.11). Although not increasing progressively, the OR for the highest risk group was significantly associated with new-onset hypovolemic shock (OR, 6.06; 95% CI, 1.47-25.00). With increasing HYPSs, median values (interquartile ranges) decreased progressively (lowest risk vs. highest risk) for ventilator-free days (23 [18-26] vs. 1 [0-21], < .001) and ICU-free days (20 [11-24] vs. 0 [0-13], < .001). Of the 729 patients in the stable subset, 598 (82%) had complete data for HYPS calculations. Logistic regression analysis showed significantly increasing ORs for the highest risk category for new-onset hypovolemic shock (OR, 7.41; 95% CI, 2.06-26.62); ICU mortality (OR, 5.08; 95% CI, 1.87-13.85); and hospital mortality (OR, 7.08; 95% CI, 2.63-19.07).
As the risk for peri-intubation hypotension increases, according to a validated hypotension prediction tool, so does the risk for adverse clinical events and certain clinical conditions.
The study was registered at ClinicalTrials.gov (NCT02508948).
气管插管（ETI）时低血压很常见且与不良结局相关。我们试图评估先前描述的ETI低血压预测评分（HYPS）是否与更差的患者结局和/或临床状况相关。
本研究是一项对前瞻性观察性多中心研究的事后分析，该研究纳入了接受ETI的成年（年龄≥18岁）重症监护病房（ICU）患者，其中HYPS是在整个队列和一个稳定亚组（即病情稳定的患者）中得出并验证的。我们评估了两个亚组中HYPS升高与几个以患者为中心的结局和临床状况之间的关联。
934例患者中有783例（84%）可获得用于计算HYPS的完整数据。逻辑回归分析显示，新发急性肾损伤最高风险类别（比值比[OR]，7.37；95%置信区间[CI]，2.58 - 21.08）、新的透析需求（OR，8.13；95% CI，1.74 - 37.91）、ICU死亡率（OR，16.39；95% CI，5.99 - 44.87）和医院死亡率（OR，18.65；95% CI，6.81 - 51.11）的OR值均升高。虽然不是逐渐升高，但最高风险组的OR与新发低血容量性休克显著相关（OR，6.06；95% CI，1.47 - 25.00）。随着HYPS升高，无呼吸机天数（23 [18 - 26]天对1 [0 - 21]天，<0.001）和无ICU天数（20 [11 - 24]天对0 [0 - 13]天，<0.001）的中位数（四分位间距）逐渐降低。在稳定亚组的729例患者中，598例（82%）可获得用于计算HYPS的完整数据。逻辑回归分析显示，新发低血容量性休克最高风险类别（OR，7.41；95% CI，2.06 - 26.62）、ICU死亡率（OR，5.08；95% CI，1.87 - 13.85）和医院死亡率（OR，7.08；95% CI，2.63 - 19.07）的OR值显著升高。
根据一个经过验证的低血压预测工具，围插管期低血压风险增加时，不良临床事件和某些临床状况的风险也会增加。
该研究已在ClinicalTrials.gov注册（NCT02508948）。
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