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Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

Published online by Cambridge University Press:  04 March 2015

Robert Green ,
Brian Hutton ,
Jason Lorette ,
Dominique Bleskie ,
Lauralyn Mclntyre  and
Dean Fergusson
Robert Green*
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, and Department of Emergency Medicine, Dalhousie University, Halifax, NS Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group
Brian Hutton
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
Jason Lorette
Affiliation:
Division of Critical Care Medicine, Department of Anesthesia, and Department of Emergency Medicine, Dalhousie University, Halifax, NS Medical Officer/Flight Surgeon, 26 Canadian Forces Health Services Center, Greenwood, NS
Dominique Bleskie
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group
Lauralyn Mclntyre
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
Dean Fergusson
Affiliation:
Ottawa Centre for Transfusion Research, Ottawa, ON on behalf of the Canadian Critical Care Trials Group Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
*
Department of Anesthesia, Division of Critical Care Medicine, Department of Emergency Medicine, Room 377 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9; Dr.Robert.Green@dal.ca

Abstract

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Objective:

Hemodynamic instability following emergent endotracheal intubation (EETI) is a potentially life-threatening adverse event. The objectives of this systematic literature review were to document the incidence of postintubation hemodynamic instability (PIHI), to determine the definitions for PIHI used in the available literature, and to examine factors associated with PIHI in adult patients who require EETI.

Data Source:

Articles published in Medline (1966–August 2012).

Study Selection:

This systematic review included adult, inhospital studies of EETIs. Studies with nonemergent or pediatric patient populations were excluded.

Data Extraction:

Two authors independently performed data abstraction. Disagreements were resolved by a third party. The methodological quality of included studies was assessed with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies.

Data Synthesis:

We estimated the pooled prevalence of PIHI across studies using a random effects meta-analysis. Subgroups analyzed included study design, intubation setting, geographic location of the study, physician experience, medications used for sedation, neuromuscular blockade, and definition of PIHI. Eighteen studies were analyzed, with sample sizes from 84 to 2,833 patients. The incidence of PIHI ranged from 5 to 440 cases per 1,000 intubations, with a pooled estimate of 110 cases per 1,000 intubations (95% CI 65–167).

Conclusions:

PIHI was found to occur in 110 cases per 1,000 in-hospital, emergent intubations. However, heterogeneity among the included studies limits the reliability of this summary estimate. Further investigation is warranted.

Keywords

emergencyhypotensionmeta-analysisrapid sequence intubationsystematic review
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 1 , January 2014 , pp. 69 - 79
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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