The Importance of Circulation in Airway Management: Preventing Postintubation Hypotension in the Trauma Bay

Objective: To identify the modifiable and nonmodifiable risk factors associated with postintubation hypotension (PIH) among trauma patients who required endotracheal intubation (ETI) in the trauma bay. Background: ETI has been associated with hemodynamic instability, termed PIH, yet its risk factors in trauma patients remain underinvestigated. Methods: This is a prospective observational study at a level I trauma center over 4 years (2019-2022). All adult (≥18) trauma patients requiring ETI in the trauma bay were included. Blood pressure was monitored both preintubation and postintubation. Multivariable logistic regression analysis was performed to identify the modifiable and nonmodifiable factors associated with PIH. Results: Seven hundred eight patients required ETI in the trauma bay, of which, 435 (61.4%) developed PIH. The mean (SD) age was 43 (21) years and 71% were male. Median [interquartile range] arrival Glasgow Coma Scale was 7 [3-13]. Patients who developed PIH had a lower mean (SD) preintubation systolic blood pressure [118 (46) vs 138 (28), P<0.001] and higher median [interquartile range] Injury Severity Score: 27 [21-38] versus 21 [9-26], P<0.001. Multivariable regression analysis identified body mass index >25, increasing Injury Severity Score, penetrating injury, spinal cord injury, preintubation packed red blood cell requirements, and diabetes mellitus as nonmodifiable risk factors associated with increased odds of PIH. In contrast, preintubation administration of 3% hypertonic saline and vasopressors were identified as the modifiable factors significantly associated with reduced PIH. Conclusions: More than half of the patients requiring ETI in the trauma bay developed PIH. This study identified modifiable and nonmodifiable risk factors that influence the development of PIH, which will help physicians when considering ETI upon patient arrival. Level of Evidence: Level III-Prognostic study.