Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
J Intensive Care Med. 2024 Sep;39(9):866-874. doi: 10.1177/08850666241235591. Epub 2024 Feb 25.
Based on current evidence, there appears to be an association between peri-intubation hypotension and patient morbidity and mortality. Studies have identified shock indices as possible pre-intubation risk factors for peri-intubation hypotension. Thus, we sought to evaluate the association between shock index (SI), modified shock index (MSI), and diastolic shock index (DSI) and peri-intubation hypotension along with other outcomes.
The present study is a sub-study of a randomized controlled trial involving critically ill patients undergoing intubation. We defined peri-intubation hypotension as a decrease in mean arterial pressure <65 mm Hg and/or a reduction of 40% from baseline; or the initiation of, or increase in infusion dosage of, any vasopressor medication (bolus or infusion) during the 30-min period following intubation. SI, MSI, and DSI were analyzed as continuous variables and categorically using pre-established cut-offs. We also explored the effect of age on shock indices.
A total of 151 patients were included in the analysis. Mean pre-intubation SI was 1.0 ± 0.3, MSI 1.5 ± 0.5, and DSI 1.9 ± 0.7. Increasing SI, MSI, and DSI were significantly associated with peri-intubation hypotension (OR [95% CI] per 0.1 increase = 1.16 [1.04, 1.30], = .009 for SI; 1.14 [1.05, 1.24], = .003 for MSI; and 1.11 [1.04, 1.19], = .003 for DSI). The area under the ROC curves did not differ across shock indices (0.66 vs 0.67 vs 0.69 for SI, MSI, and DSI respectively; = .586). Increasing SI, MSI, and DSI were significantly associated with worse sequential organ failure assessment (SOFA) score (spearman rank correlation: r = 0.30, r = 0.40, and r = 0.45 for SI, MSI, and DSI, respectively, all < .001) but not with other outcomes. There was no significant impact when incorporating age.
Increasing SI, MSI, and DSI were all significantly associated with peri-intubation hypotension and worse SOFA scores but not with other outcomes. Shock indices remain a useful bedside tool to assess the potential likelihood of peri-intubation hypotension.
ClinicalTrials.gov identifier - NCT02105415.
根据现有证据，围插管期间低血压似乎与患者发病率和死亡率有关。研究已经确定休克指数可作为围插管期间低血压的潜在插管前危险因素。因此，我们试图评估休克指数（SI）、改良休克指数（MSI）和舒张期休克指数（DSI）与围插管期间低血压以及其他结局之间的关系。
本研究是一项涉及接受插管的危重症患者的随机对照试验的子研究。我们将围插管期间低血压定义为平均动脉压下降<65mmHg 和/或与基线相比下降 40%；或在插管后 30 分钟内开始使用或增加任何血管加压药物（推注或输注）。SI、MSI 和 DSI 被分析为连续变量和使用预先设定的截止值进行分类。我们还探讨了年龄对休克指数的影响。
共纳入 151 例患者进行分析。插管前平均 SI 为 1.0 ± 0.3，MSI 为 1.5 ± 0.5，DSI 为 1.9 ± 0.7。SI、MSI 和 DSI 的增加与围插管期间低血压显著相关（每增加 0.1，OR [95%CI]分别为 1.16 [1.04, 1.30]，= 0.009；1.14 [1.05, 1.24]，= 0.003；1.11 [1.04, 1.19]，= 0.003）。ROC 曲线下面积在不同休克指数之间没有差异（SI、MSI 和 DSI 的 AUC 分别为 0.66、0.67 和 0.69；= 0.586）。SI、MSI 和 DSI 的增加与序贯器官衰竭评估（SOFA）评分恶化显著相关（Spearman 秩相关：r 分别为 0.30、0.40 和 0.45，均<0.001），但与其他结局无关。当纳入年龄时，没有显著影响。
SI、MSI 和 DSI 的增加均与围插管期间低血压和更严重的 SOFA 评分显著相关，但与其他结局无关。休克指数仍然是一种有用的床边工具，可用于评估围插管期间低血压的可能性。
ClinicalTrials.gov 标识符-NCT02105415。
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