The impact of post-intubation hypotension on length of stay and mortality in adult and geriatric patients: a cohort study

Objective To evaluate the association between standard post-intubation hypotension (< 90 mmHg) and in-hospital mortality. Secondary objectives were to evaluate the association of post-intubation hypotension and length of stay and to assess the impact of increasing post-intubation hypotension threshold to 110 mmHg on hospital length of stay and 48 h-mortality in patients aged ≥ 65 years. Methods Design and setting : A cohort of patients admitted in a level-1 trauma centre emergency department (ED) between November 2011 and July 2016. Inclusion criteria : aged ≥ 16 with available pre-intubation vital signs, intubation performed in ≤ 3 attempts with no surgical access needed. Measures : Prospective electronic data collection was used for clinical data. Main outcome : 48-h in-hospital mortality. Secondary outcome : hospital length of stay. Analyses : Univariate and multivariate analyses. Results A total of 586 patients were included. The mean age was 56.3 ± 18.8 years and 37% were aged ≥ 65 years. Within 60 min of intubation, 224 (38%) patients had at least one systolic blood pressure measure < 90 mmHg and 164(28%) had at least two measures. The < 110 mmHg threshold showed a total of 377 patients (64%) had at least one systolic blood pressure measure < 110 mmHg and 286 (49%) had at least two measures. We found no significant difference in the risk of mortality overall and in stratified-age groups and no association with increased hospital length of stay using both post-intubation hypotension thresholds. Conclusion Post-intubation hypotension was recorded in one out of three patients in the ED but we found no association between post-intubation hypotension and 48-h in-hospital mortality overall in adults or geriatric patients.