Prehospital Postintubation Hypotension and Survival in Severe Traumatic Brain Injury

1. Prehospital postintubation hypotension after traumatic brain injury (TBI) is common and associated with a significantly increased incidence of mortality.

Evidence Rating Level: 2 (Good)

Preventing systemic insults from hypotension, hypoxia, and hypocapnia is key to improving outcomes after TBI. However, a substantial proportion of patients with TBI require prehospital rapid sequence intubation, which can cause postintubation hypotension. This retrospective, multicenter, observational cohort study measured the association between postintubation hypotension (systolic blood pressure (SBP) <90 mmHg at 10 minutes or less of induction) and 30-day mortality for patients with severe TBI (head Abbreviated Injury Score (AIS) ≥ 3). Of 1539 patients (median [IQR] age: 48[29-66]; 73.5% male), 19.1% had postintubation hypotension. Postintubation hypotension was significantly associated with increased 30-day mortality (AOR, 1.70; 95% CI, 1.01-2.86; P = 0.04). Furthermore, statistically significant differences in mortality were observed for postintubation SBP up to 100 mmHg. This observation remained when looking at patients with isolated severe TBI (head AIS score ≥3 and all other body region AIS scores <3) who had postintubation hypotension (AOR, 13.55; 95% CI, 3.65-61.66; P < 0.001). These findings suggest postintubation hypotension is common and associated with increased mortality. Further studies should assess ways to reduce the incidence of postintubation hypotension in the prehospital setting when advanced airway management is required.

Click here to read the study in JAMA Network Open

Image: PD

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