The following is a summary of “Incidence of cardiovascular instability in patients receiving various vasopressor strategies for peri-intubation hypotension,” published in the March 2023 issue of Emergency Medicine by Schmitt, et al.

The peri-intubation interval is characterized by frequent hypotension in patients. The underlying illness process, the physiologic reaction to the intervention, or a negative pharmaceutical impact could all be to blame. The duration of hypotension can be either short or long due to the variability of its causes. There were several methods for starting vasopressors for peri-intubation hypotension using push-dose phenylephrine (PDPE) or continuous infusion norepinephrine (NE) to achieve the desired mean arterial pressure. There needed to be more information explaining the results of cardiovascular stability in individuals taking vasopressors for peri-intubation hypotension.

Those who received vasopressors for hypotension within 30 minutes of intubation were included in the retrospective cohort analysis of emergency department patients from three university medical institutions and smaller health system sites. Depending on whether they received PDPE alone, continuous infusion NE alone, or PDPE followed by continuous infusion NE, patients were matched based on variables that were likely to affect the choice of vasopressor. The main result was the frequency of hypotension (systolic blood pressure <90 mmHg), bradycardia (HR <60 bpm), and cardiac arrest within 2 hours of starting vasopressors.

About 2,518 patients underwent screening, and 105 underwent matching. Following intubation, the average time to start a vasopressor was 10 minutes. The composite primary outcome occurred in 88.6%, 80.0%, and 88.6% of the NE, PDPE, and PDPE+NE groups, respectively, and there was no statistically significant difference between the groups. In a subgroup analysis, patients who were diagnosed with sepsis or septic shock in the ED were more likely to receive PDPE before beginning continuous infusion NE (41.3% vs. 27.1%, P = 0.075), and they also had a higher incidence of the primary composite outcome (P = 0.045). However, the factors were unrelated to using vasopressors (P = 0.55).

No matter whether the vasopressor method was chosen, cardiovascular instability after vasopressor beginning for peri-intubation hypotension occurred. Those who were diagnosed with sepsis or septic shock experienced it. Vasopressor selection should continue to take patient-specific characteristics and product accessibility into account.

Reference: sciencedirect.com/science/article/pii/S073567572200763X