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Article in Korean | WPRIM | ID: wpr-716393


OBJECTIVE: Hypotension after emergent endotracheal intubation is a serious complication related to in-hospital mortality. We investigated factors including modified shock index to predict the development of hypotension after emergent intubation. METHODS: This retrospective observational study was conducted between January 2011 and December 2016. The study population included intubated patients among all medical patients admitted to the emergency department (ED) except for patients whose systolic blood pressure was below 90 mmHg at any time before intubation. The postintubation hypotension (PIH) groups were compared with the non-PIH group. The secondary outcome was in-hospital mortality. RESULTS: A total of 285 patients were included in this study, of which 92 patients (32.3%) PIH. The age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.06; P=0.001), serum albumin level (OR, 0.62; 95% CI, 0.41–0.92; P=0.019), shock index (OR, 3.25; 95% CI, 1.26–8.38; P=0.015), and modified shock index (MSI) (OR, 2.18; 95% CI, 1.06–4.47; P=0.034) were more closely associated with PIH than any other factors. The average survival of the PIH group was significantly shorter than that of the non-PIH group (13.6±3.5 vs. 35.6±12.0, log-rank test P=0.019). CONCLUSION: Overall, 32.3% of hemodynamically stable medical patients developed PIH in ED. MSI was associated with PIH.

Blood Pressure , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Hospital Mortality , Humans , Hypotension , Intubation , Intubation, Intratracheal , Mortality , Observational Study , Retrospective Studies , Risk Factors , Serum Albumin , Shock
Article in English | WPRIM | ID: wpr-163109


PURPOSE: Hypotension after emergency endotracheal intubation (ETI) is one of the major complications from emergency airway management. The aim of this study was to determine the possible risk factors that may predict postintubation hypotension (PIH) and its impact on in-hospital mortality. METHODS: We conducted a retrospective, standardized chart review of consecutive emergency department patients that required intubation between January 2011 and December 2014. Patients were divided into 2 groups according to the presence or absence of PIH. PIH was defined as any recorded systolic blood pressure with less than 90 mmHg or mean arterial pressure with less than 65 mmHg within the 60-minute period after intubation. The outcome measures were inhospital mortality, as well as intensive care unit and hospital length of stay. RESULTS: The incidence of PIH was 23% (80 of 352 patients). Patients in the PIH group were slightly older and had more comorbid diseases than those in the non-PIH group. PIH patients had a significantly higher mortality rate (54% vs. 30%, p<0.01). PIH was a strong predictor for in-hospital mortality of intubated patients (hazard ratio, 2.3; 95% confidence interval, 1.3 to 3.4). CONCLUSION: Older age, lack of skill, history of hypertension, low albumin and pH, and elevated were risk factors for the occurrence of hypotension after ETI. Patients with PIH show increased risk of in-hospital mortality.

Airway Management , Arterial Pressure , Blood Pressure , Emergencies , Emergency Service, Hospital , Hospital Mortality , Humans , Hydrogen-Ion Concentration , Hypertension , Hypotension , Incidence , Intensive Care Units , Intubation , Intubation, Intratracheal , Length of Stay , Mortality , Outcome Assessment, Health Care , Retrospective Studies , Risk Factors
Article in English | WPRIM | ID: wpr-49198


PURPOSE: The aim of this study is to evaluate the clinical characteristics and outcomes of patients with cardiac arrest without obvious extracardiac cause who underwent emergency angiography to determine the factors related to significant coronary artery disease in patients in whom coronary angiography was performed. We also addressed the issues around the survival benefit of coronary angiography and subsequent coronary intervention. METHODS: In total 91 patients during the period between 2004 and 2012 were included in the study. Clinical characteristics and coronary angiographic data were collected retrospectively. The success measurement of the study was set as survival at the time of hospital discharge. RESULTS: In comparison of the demographic and clinical variables of patients with and without emergency coronary angiography, only the electrocardiogram differed significantly between the two groups. Fifty four patients underwent an emergency coronary angiography, which was performed later for the remaining seven patients. Acute coronary lesions were observed in 38 patients (62%). Findings of electrocardiograms before and after return of spontaneous circulation (ROSC) were not statistically significant in relation to the prevalence of a culprit lesion. Neither an emergency coronary angiography nor successful coronary intervention showed correlation with survival at the time of hospital discharge. A shorter duration to return of spontaneous circulation, an initial shockable rhythm, and the absence of shock were found to be independent factors affecting discharge of patients alive in the overall study population (n=91). CONCLUSION: Considering the angiographic findings, neither the presence of a shockable rhythm nor ST-segment elevation myocardial infarction (STEMI) before and after ROSC were factors favouring acute coronary artery disease. The emergency coronary angiography did not show correlation with survival at hospital discharge in patients with a resuscitated cardiac arrest without non-cardiac cause. Factors positively related to survival should be considered when deciding on coronary angiography in order to identify patients in whom routine angiography is futile (e.g., the delay for return of spontaneous circulation and presence of shock).

Angiography , Cardiopulmonary Resuscitation , Coronary Angiography , Coronary Artery Disease , Electrocardiography , Emergencies , Heart Arrest , Humans , Myocardial Infarction , Out-of-Hospital Cardiac Arrest , Prevalence , Retrospective Studies , Shock
Article in Korean | WPRIM | ID: wpr-126649


PURPOSE: Arterial hypotension is a recognized complication of emergency intubation, whereas there have been contradicting opinions regarding postintubation hypotension. The aim of this study was to determine the incidence, related factors, and impact on patient outcomes associated with postintubation hypotension (PIH) in intubations performed in the emergency department. METHODS: A structured chart audit of all consecutive adult patients requiring emergency endotracheal intubations over a two-year period (2011.1.1.~2012.12.31.) was performed retrospectively. Patients older than 20 years who had no systolic blood pressure below 90 mmHg at any time before intubation were included. Patients were analyzed in two groups, those with PIH, defined as any recorded systolic pressure less than 90 mmHg within 60 minutes of intubation, and those with no PIH. The primary outcome was in-hospital mortality. RESULTS: Overall, 186 patients intubated in the emergency department were identified, and 18.4% (34 of 186) developed PIH. Advanced age was an independent factor of developing PIH (OR: 3.4, 95% CI: 1.3-9.0, p=0.02). Patients with PIH had significantly higher in-hospital mortality (53% vs 29%; p=0.01), and multiple logistic regression showed that PIH was an independent predictor of in-hospital mortality (OR: 2.5, 95% CI: 1.1-5.5 p=0.03). CONCLUSION: Postintubation hypotension occurs in 18.3% of hemodynamically stable patients before intubation. PIH is independently associated with in-hospital mortality. Advanced age is an independent predicting factor of PIH.

Adult , Blood Pressure , Emergencies , Emergency Service, Hospital , Hospital Mortality , Humans , Hypotension , Incidence , Intubation , Intubation, Intratracheal , Logistic Models , Mortality , Retrospective Studies , Risk Factors