Postintubation Hemodynamic Collapse in Traumatically Injured Critical Care Transport Patients: A Retrospective Cohort...

Area of Science:

• Trauma critical care
• Emergency medicine
• Cardiovascular physiology

Background:

• Endotracheal intubation in trauma patients carries risks, notably post-intubation hemodynamic collapse.
• Hypotension following intubation increases the risk of secondary harm in trauma patients.

Purpose of the Study:

• To describe the incidence of post-intubation hemodynamic collapse in traumatically injured patients.
• To investigate associations between pre-intubation factors and hemodynamic collapse.
• To examine in-hospital outcomes related to hemodynamic collapse.

Main Methods:

• Retrospective chart review of 142 trauma patients intubated by a hospital-based CCT service.
• Hemodynamic collapse defined by cardiac arrest, low SBP, new vasopressor use, or fluid bolus.
• Analysis of patient risk factors and in-hospital outcomes, including mortality.

Main Results:

• 24.6% of trauma patients experienced hemodynamic collapse post-intubation.
• Pre-intubation blood administration, vasopressors, and initial low SBP were associated with higher odds of collapse.
• Higher median shock index and Injury Severity Scores (ISS) were observed in patients with collapse.

Conclusions:

• Post-intubation hemodynamic collapse is a significant concern, affecting 1 in 4 trauma patients.
• Patients experiencing collapse were more likely to have received blood, fluids, and vasopressors.
• Careful consideration of risks and benefits is crucial when securing definitive airways in these high-risk patients.