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Avoidance of post-intubation arterial hypotension with push-dose metaraminol: a multicentre retrospective cohort

Fernando da Silveira1, Wagner Nedel1, Tiago Antonio Tonietto2

  • 1Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Pneumológicas - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Heart & Lung : the Journal of Critical Care
|May 22, 2026
PubMed
Abstract

Insights

Prophylactic push-dose metaraminol significantly reduced post-intubation hypotension and early vasopressor needs in septic ICU patients undergoing orotracheal intubation. This intervention did not increase adverse events, offering a safer approach to intubation management.

Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Anesthesiology

Background:

  • Post-intubation arterial hypotension is a common complication in septic ICU patients, potentially worsening outcomes.
  • The efficacy of prophylactic push-dose metaraminol in preventing hypotension during orotracheal intubation in this population is not well-established.

Purpose of the Study:

  • To determine if prophylactic push-dose metaraminol reduces arterial hypotension following orotracheal intubation in septic ICU patients.
  • To assess the association between push-dose metaraminol and key secondary outcomes, including vasopressor use and adverse events.

Main Methods:

  • A multicentre retrospective cohort study involving 349 adult septic ICU patients requiring mechanical ventilation.
  • Comparison between patients receiving prophylactic push-dose metaraminol (PDP group) versus those who did not (no-PDP group) during intubation.
  • Primary outcome: post-intubation arterial hypotension; Secondary outcomes: noradrenaline requirement, fluid balance, organ dysfunction, and adverse events.

Main Results:

  • Post-intubation hypotension was significantly less frequent in the PDP group (21.1%) compared to the no-PDP group (49.4%).
  • Early noradrenaline requirement at 1 hour post-intubation was lower in the PDP group (43.8%) versus the no-PDP group (58.2%).
  • No significant differences were observed in 7-day or 28-day mortality, and adverse events were comparable between groups.

Conclusions:

  • Prophylactic push-dose metaraminol administration during orotracheal intubation in septic ICU patients is associated with a significant reduction in post-intubation hypotension.
  • The use of prophylactic push-dose metaraminol also led to a decreased need for early vasopressor support.
  • This strategy appears safe, as it was not linked to an increase in adverse events or mortality.
Keywords:
Airway managementHypotensionIntratrachealIntubationMetaraminolSepsisVasoconstrictor agents

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