Risk factors for hypotension in urgently intubated burn patients

Christopher J. Dennis, Kevin K. Chung, Seth R. Holland, Brian S. Yoon, Daun J. Milligan, Stephanie L. Nitzschke, Christopher V. Maani, Jacob J. Hansen, James K. Aden, Evan M. Renz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability. Methods: A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality. Results: Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n = 168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004-1.027, p < 0.001) and presumed sepsis (OR 1.852, 95% CI 1.100-3.117, p = 0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis. Conclusions: In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors.

Original languageEnglish (US)
Pages (from-to)1181-1185
Number of pages5
JournalBurns
Volume38
Issue number8
DOIs
StatePublished - Dec 2012

Fingerprint

Hypotension
Intubation
Propofol
Sepsis
Intratracheal Intubation
Critical Illness
Intensive Care Units
Etomidate
Midazolam
Ketamine
Mechanical Ventilators
Hospital Mortality
Burns
Resuscitation
Length of Stay
Logistic Models
Hemodynamics
Demography

Keywords

  • Burns
  • Critical care
  • Induction
  • Intubation
  • Propofol
  • Respiratory failure

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Dennis, C. J., Chung, K. K., Holland, S. R., Yoon, B. S., Milligan, D. J., Nitzschke, S. L., ... Renz, E. M. (2012). Risk factors for hypotension in urgently intubated burn patients. Burns, 38(8), 1181-1185. https://doi.org/10.1016/j.burns.2012.07.004

Risk factors for hypotension in urgently intubated burn patients. / Dennis, Christopher J.; Chung, Kevin K.; Holland, Seth R.; Yoon, Brian S.; Milligan, Daun J.; Nitzschke, Stephanie L.; Maani, Christopher V.; Hansen, Jacob J.; Aden, James K.; Renz, Evan M.

In: Burns, Vol. 38, No. 8, 12.2012, p. 1181-1185.

Research output: Contribution to journalArticle

Dennis, CJ, Chung, KK, Holland, SR, Yoon, BS, Milligan, DJ, Nitzschke, SL, Maani, CV, Hansen, JJ, Aden, JK & Renz, EM 2012, 'Risk factors for hypotension in urgently intubated burn patients', Burns, vol. 38, no. 8, pp. 1181-1185. https://doi.org/10.1016/j.burns.2012.07.004
Dennis CJ, Chung KK, Holland SR, Yoon BS, Milligan DJ, Nitzschke SL et al. Risk factors for hypotension in urgently intubated burn patients. Burns. 2012 Dec;38(8):1181-1185. https://doi.org/10.1016/j.burns.2012.07.004
Dennis, Christopher J. ; Chung, Kevin K. ; Holland, Seth R. ; Yoon, Brian S. ; Milligan, Daun J. ; Nitzschke, Stephanie L. ; Maani, Christopher V. ; Hansen, Jacob J. ; Aden, James K. ; Renz, Evan M. / Risk factors for hypotension in urgently intubated burn patients. In: Burns. 2012 ; Vol. 38, No. 8. pp. 1181-1185.
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title = "Risk factors for hypotension in urgently intubated burn patients",
abstract = "Background: When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability. Methods: A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality. Results: Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60{\%} (n = 168) of the intubations. After intubation, 117 patients (42{\%}) experienced clinically significant hypotension. Propofol (51{\%}) was the most commonly utilized induction agent followed by etomidate (23{\%}), ketamine (15{\%}), and midazolam (11{\%}). On multiple logistic regression, {\%}TBSA (OR 1.016, 95{\%} CI 1.004-1.027, p < 0.001) and presumed sepsis (OR 1.852, 95{\%} CI 1.100-3.117, p = 0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis. Conclusions: In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and {\%}TBSA were the most important risk factors.",
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AU - Dennis, Christopher J.

AU - Chung, Kevin K.

AU - Holland, Seth R.

AU - Yoon, Brian S.

AU - Milligan, Daun J.

AU - Nitzschke, Stephanie L.

AU - Maani, Christopher V.

AU - Hansen, Jacob J.

AU - Aden, James K.

AU - Renz, Evan M.

PY - 2012/12

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N2 - Background: When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability. Methods: A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality. Results: Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n = 168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004-1.027, p < 0.001) and presumed sepsis (OR 1.852, 95% CI 1.100-3.117, p = 0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis. Conclusions: In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors.

AB - Background: When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability. Methods: A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality. Results: Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n = 168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004-1.027, p < 0.001) and presumed sepsis (OR 1.852, 95% CI 1.100-3.117, p = 0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis. Conclusions: In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors.

KW - Burns

KW - Critical care

KW - Induction

KW - Intubation

KW - Propofol

KW - Respiratory failure

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