Impact of Interventions on Peri-Intubation Hypoxemia and Hypotension in Critically Ill Patients: Systematic Review...

Emergent endotracheal intubation is common in critically ill patients. Underlying pathophysiologic derangements puts these patients at increased risk of peri-intubation major adverse events (MAE) and have been associated with higher morbidity and mortality. Investigating the impact of interventions in the peri-intubation period on the rate of peri-intubation hypoxemia and hypotension can help improve management of emergent airways.

We searched PubMed, Embase, and Scopus databases from their beginning through April 2024 to identify randomized controlled trials (RCT) evaluating interventions to prevent peri-intubation hypoxemia and hypotension. Random-effects meta-analysis was used for the outcomes of peri-intubation hypoxemia and hypotension. We used the Cochrane risk-of-bias tool and Cochrane Q-statistic and I2 to assess the quality and heterogeneity of the included studies, respectively.

We included 16 RCTs included in our analysis with a total of 7,778 patients. All studies reported incidences of peri-intubation hypoxemia, and 11 studies reported rates of hypotension. One study had some concern of bias; otherwise all others were found to have low risk of bias. The examined interventions were associated with a 25% reduction in rates of hypoxemia (OR 0.748, 95% CI 0.566 - 0.988, P = .04). The subgroup of preoxygenation techniques showed a 63% reduction in rates of hypoxemia (OR 0.37, 95% CI 0.23 - 0.61, P < .001). Interventions to prevent hypotension were not associated with a significant decrease in rates of peri-intubation hypotension (OR 0.848, CI 0.676 - 1.063, P = .15).

Preoxygenation interventions, in the form of noninvasive ventilation, are associated with lower odds of hypoxemia in the peri-intubation period. More research is needed to determine whether interventions can be successful at preventing cardiovascular collapse.