Risk Factors and Prognostic Implications of Post-Intubation Hypotension in Emergency Department Critical Care Patients: A Retrospective Cohort Study
Authors: Huang Zheng , Wen MA Zeng , Yun Xu Shu 
Published: January 2025

Objective: To investigate the risk factors and patient prognosis after the implementation of tracheal intubation in critically ill patients in the emergency department and to provide a theoretical basis for the development of clinical decisions for the treatment of critically ill patients in the emergency department.
Methods: According to the inclusion and exclusion criteria, the clinical data of tracheal intubation patients admitted to the Emergency Department of Huaxi Shangjin Nanfu Hospital during the period of 1 January 2020–2022 were collected and analyzed. The patients were divided into the hypotensive group and the normotensive group according to whether hypotension occurred after tracheal intubation. A univariate analysis was used to analyze the risk factors for the development of hypotension in patients after intubation, and a multifactorial logistic regression analysis was performed to determine the independent risk factors for hypotension after intubation. The efficacy of each variable in predicting the development of hypotension in intubated patients was analyzed using a subject’s work characteristics (ROC) curve. The 28-day mortality rate, number of days in the ICU, and number of days in the hospital were compared between the two groups.
Results: Hypotension occurred in 48 of 155 patients after tracheal intubation. Univariate analysis showed statistically significant differences between groups for 18 factors, including body mass index, preintubation systolic blood pressure, preintubation diastolic blood pressure, preintubation heart rate, postintubation diastolic blood pressure, postintubation heart rate, preintubation hemoglobin, preintubation creatinine, preintubation albumin, preintubation potassium, preintubation glucose, preintubation pH, postintubation neutrophil percentage, postintubation blood glucose, postintubation blood pH, postintubation PCO2, postintubation HCO3, and preintubation inducer use (P < 0.05). Logistic regression analysis showed that body mass index and pre-tracheal intubation systolic blood pressure were the independent risk factors for the development of hypotension in patients after tracheal intubation (P < 0.05). ROC analysis showed that the area under the curve (AUC) of body mass index predicting post-tracheal intubation hypotension was 0.734, with a 95% CI of 0.657–0.802 (P < 0.05), and the sensitivity and specificity of prediction were 52.08% and 84.11%, respectively. The area under the curve (AUC) of pre-tracheal systolic blood pressure predicting post-tracheal intubation hypotension was 0.894, with a 95% CI of 0.835–0.938 (P < 0.05), the optimal threshold was 90, the sensitivity of prediction was 87.50%, and the specificity was 83.18%. The area under the curve (AUC) of body mass index combined with preintubation systolic blood pressure to predict post-tracheal intubation hypotension was 0.934, with a sensitivity of prediction of 89.60% and a specificity of 83.20%. The 28-day mortality rate was significantly higher in the hypotensive group than in the non-hypotensive group (41.67% vs. 19.63%, P = 0.004), and the number of ICU days (4.804 ± 1.321 vs. 9.896 ± 2.868, P < 0.001) and the number of days of hospitalization (20.598 ± 5.297 vs. 25.354 ± 5.602, P < 0.001) were significantly prolonged in the hypotensive group compared with the non-hypotensive group.
Conclusion: Hypotension after tracheal intubation in critically ill patients is more common in patients with low body weight or low systolic blood pressure before intubation, and hypotension after intubation increases the number of days in the ICU, the number of hospitalization days, and the 28-day mortality rate.