J Korean Soc Emerg Med.  2018 Aug;29(4):358-363. 10.0000/jksem.2018.29.4.358.

The usefulness of modified shock index for prediction of postintubation hypotension in emergency department

• Jang J
• Lee K
• Kim I
• Kim H
• Kim J

• KMID: 2435487
• DOI: http://doi.org/10.0000/jksem.2018.29.4.358

Abstract

OBJECTIVE
Hypotension after emergent endotracheal intubation is a serious complication related to in-hospital mortality. We investigated factors including modified shock index to predict the development of hypotension after emergent intubation.
METHODS
This retrospective observational study was conducted between January 2011 and December 2016. The study population included intubated patients among all medical patients admitted to the emergency department (ED) except for patients whose systolic blood pressure was below 90 mmHg at any time before intubation. The postintubation hypotension (PIH) groups were compared with the non-PIH group. The secondary outcome was in-hospital mortality.
RESULTS
A total of 285 patients were included in this study, of which 92 patients (32.3%) PIH. The age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; P=0.001), serum albumin level (OR, 0.62; 95% CI, 0.41-0.92; P=0.019), shock index (OR, 3.25; 95% CI, 1.26-8.38; P=0.015), and modified shock index (MSI) (OR, 2.18; 95% CI, 1.06-4.47; P=0.034) were more closely associated with PIH than any other factors. The average survival of the PIH group was significantly shorter than that of the non-PIH group (13.6±3.5 vs. 35.6±12.0, log-rank test P=0.019).
CONCLUSION
Overall, 32.3% of hemodynamically stable medical patients developed PIH in ED. MSI was associated with PIH.

Keyword

Intubation; Hypotension; Risk factors; Mortality; Emergency medical services; Hospitals

MeSH Terms

Blood Pressure
Emergencies*
Emergency Medical Services
Emergency Service, Hospital*
Hospital Mortality
Humans
Hypotension*
Intubation
Intubation, Intratracheal
Mortality
Observational Study
Retrospective Studies
Risk Factors
Serum Albumin
Shock*
Serum Albumin