Suga Masafumi, Nishimura Takeshi, Ochi Tatsuya, Hongo Takashi, Yumoto Tetsuya, Nakao Atsunori, Ishihara Satoshi, Naito Hiromichi
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama City, Okayama, 700-8558, Japan.
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, chuo-ku, Kobe, Hyogo, 651-0073, Japan.
Heliyon. 2024 Nov 21;10(23):e40224. doi: 10.1016/j.heliyon.2024.e40224. eCollection 2024 Dec 15.
Post-intubation hypotension (PIH) is a common complication of intubations performed in the emergency department (ED). Identification of patients at high-risk for PIH is a major challenge. We aimed to determine whether pre-intubation metabolic acidosis affects the incidence of PIH in the ED.
This was a single-center, retrospective, observational study of consecutive patients requiring emergent endotracheal intubation (ETI) from November 1, 2016 to March 31, 2022 at Hyogo Emergency Medical Center, an urban ED. The primary outcome was PIH, defined as a decreased systolic blood pressure (sBP) of <90 mmHg, required initiation of any vasopressor, or a decrease in sBP by ≥ 20 % within 30 min following intubation. Patients were divided into two groups: those with pre-intubation metabolic acidosis (metabolic acidosis group), defined as pH < 7.3 and base excess (BE) < -4 mmol/L on arterial blood gas analysis, and those with no metabolic acidosis (without-metabolic acidosis group). The association between PIH and pre-intubation metabolic acidosis was examined using multivariable logistic regression models. A receiver operating characteristic (ROC) curve was produced to assess the predictive value of pre-intubation BE for PIH.
The study included 311 patients. PIH occurred in 65.5 % (74/113) of patients in the metabolic acidosis group and 29.3 % (58/198) of patients in the without-metabolic acidosis group. Multivariable logistic regression demonstrated that metabolic acidosis was associated with PIH (odds ratio 4.06, 95 % confidence interval 2.31-7.11). In the ROC analysis, the optimal cut-off point for BE was -4.1 (sensitivity = 71 %, specificity = 70 %), with the area under the ROC curve 0.74.
Pre-intubation metabolic acidosis was significantly associated with PIH. Physicians.
插管后低血压（PIH）是急诊科（ED）进行插管操作时常见的并发症。识别PIH高危患者是一项重大挑战。我们旨在确定插管前代谢性酸中毒是否会影响急诊科PIH的发生率。
这是一项在日本兵库县急救医疗中心（一家城市急诊科）进行的单中心、回顾性观察研究，研究对象为2016年11月1日至2022年3月31日期间连续需要紧急气管插管（ETI）的患者。主要结局是PIH，定义为收缩压（sBP）下降至<90 mmHg，需要启动任何血管升压药，或插管后30分钟内sBP下降≥20%。患者分为两组：插管前代谢性酸中毒患者（代谢性酸中毒组），定义为动脉血气分析pH<7.3且碱剩余（BE）<-4 mmol/L；无代谢性酸中毒患者（无代谢性酸中毒组）。使用多变量逻辑回归模型检查PIH与插管前代谢性酸中毒之间的关联。绘制受试者工作特征（ROC）曲线以评估插管前BE对PIH的预测价值。
该研究纳入了311例患者。代谢性酸中毒组65.5%（74/113）的患者发生了PIH，无代谢性酸中毒组29.3%（58/198）的患者发生了PIH。多变量逻辑回归表明，代谢性酸中毒与PIH相关（比值比4.06，95%置信区间2.31-7.11）。在ROC分析中，BE的最佳截断点为-4.1（敏感性=71%，特异性=70%），ROC曲线下面积为0.74。
插管前代谢性酸中毒与PIH显著相关。医生。
