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Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study

BACKGROUND: Post-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in adult trauma patients undergoing PHEA. METHODS: Thi...

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Autores principales: Price, James, Moncur, Lyle, Lachowycz, Kate, Major, Rob, Sagi, Liam, McLachlan, Sarah, Keeliher, Chris, Steel, Alistair, Sherren, Peter B., Barnard, Ed B. G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236576/
https://www.ncbi.nlm.nih.gov/pubmed/37268976
http://dx.doi.org/10.1186/s13049-023-01091-z
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author Price, James
Moncur, Lyle
Lachowycz, Kate
Major, Rob
Sagi, Liam
McLachlan, Sarah
Keeliher, Chris
Steel, Alistair
Sherren, Peter B.
Barnard, Ed B. G.
author_facet Price, James
Moncur, Lyle
Lachowycz, Kate
Major, Rob
Sagi, Liam
McLachlan, Sarah
Keeliher, Chris
Steel, Alistair
Sherren, Peter B.
Barnard, Ed B. G.
author_sort Price, James
collection PubMed
description BACKGROUND: Post-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in adult trauma patients undergoing PHEA. METHODS: This multi-centre retrospective observational study was performed across three Helicopter Emergency Medical Services (HEMS) in the UK. Consecutive sampling of trauma patients who underwent PHEA using a fentanyl, ketamine, rocuronium drug regime were included, 2015–2020. Hypotension was defined as a new systolic blood pressure (SBP) < 90 mmHg within 10 min of induction, or > 10% reduction if SBP was < 90 mmHg before induction. A purposeful selection logistic regression model was used to determine pre-PHEA variables associated with PIH. RESULTS: During the study period 21,848 patients were attended, and 1,583 trauma patients underwent PHEA. The final analysis included 998 patients. 218 (21.8%) patients had one or more episode(s) of hypotension ≤ 10 min of induction. Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. Induction drug regimes in which fentanyl was omitted (0:1:1 and 0:0:1 (rocuronium-only)) were the determinants with the largest effect sizes associated with hypotension. CONCLUSION: The variables significantly associated with PIH only account for a small proportion of the observed outcome. Clinician gestalt and provider intuition is likely to be the strongest predictor of PIH, suggested by the choice of a reduced dose induction and/or the omission of fentanyl during the anaesthetic for patients perceived to be at highest risk.
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spelling pubmed-102365762023-06-03 Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study Price, James Moncur, Lyle Lachowycz, Kate Major, Rob Sagi, Liam McLachlan, Sarah Keeliher, Chris Steel, Alistair Sherren, Peter B. Barnard, Ed B. G. Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Post-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in adult trauma patients undergoing PHEA. METHODS: This multi-centre retrospective observational study was performed across three Helicopter Emergency Medical Services (HEMS) in the UK. Consecutive sampling of trauma patients who underwent PHEA using a fentanyl, ketamine, rocuronium drug regime were included, 2015–2020. Hypotension was defined as a new systolic blood pressure (SBP) < 90 mmHg within 10 min of induction, or > 10% reduction if SBP was < 90 mmHg before induction. A purposeful selection logistic regression model was used to determine pre-PHEA variables associated with PIH. RESULTS: During the study period 21,848 patients were attended, and 1,583 trauma patients underwent PHEA. The final analysis included 998 patients. 218 (21.8%) patients had one or more episode(s) of hypotension ≤ 10 min of induction. Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. Induction drug regimes in which fentanyl was omitted (0:1:1 and 0:0:1 (rocuronium-only)) were the determinants with the largest effect sizes associated with hypotension. CONCLUSION: The variables significantly associated with PIH only account for a small proportion of the observed outcome. Clinician gestalt and provider intuition is likely to be the strongest predictor of PIH, suggested by the choice of a reduced dose induction and/or the omission of fentanyl during the anaesthetic for patients perceived to be at highest risk. BioMed Central 2023-06-02 /pmc/articles/PMC10236576/ /pubmed/37268976 http://dx.doi.org/10.1186/s13049-023-01091-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research
Price, James
Moncur, Lyle
Lachowycz, Kate
Major, Rob
Sagi, Liam
McLachlan, Sarah
Keeliher, Chris
Steel, Alistair
Sherren, Peter B.
Barnard, Ed B. G.
Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
title Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
title_full Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
title_fullStr Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
title_full_unstemmed Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
title_short Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
title_sort predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236576/
https://www.ncbi.nlm.nih.gov/pubmed/37268976
http://dx.doi.org/10.1186/s13049-023-01091-z
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