Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability
Abstract Background Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-07-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-022-01043-3 |
| _version_ | 1818192936208171008 |
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| author | Vincent Dubée Geoffroy Hariri Jérémie Joffre Julien Hagry Lisa Raia Vincent Bonny Paul Gabarre Sebastien Ehrminger Naike Bigé Jean-Luc Baudel Bertrand Guidet Eric Maury Guillaume Dumas Hafid Ait-Oufella |
| author_facet | Vincent Dubée Geoffroy Hariri Jérémie Joffre Julien Hagry Lisa Raia Vincent Bonny Paul Gabarre Sebastien Ehrminger Naike Bigé Jean-Luc Baudel Bertrand Guidet Eric Maury Guillaume Dumas Hafid Ait-Oufella |
| author_sort | Vincent Dubée |
| collection | DOAJ |
| description | Abstract Background Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic instability (PIHI). Methods Prospective observational monocenter study conducted in an 18-bed medical ICU. Consecutive patients requiring tracheal intubation were eligible for the study. Global hemodynamic parameters (blood pressure, heart rate, cardiac function) and tissue perfusion parameters (arterial lactate, mottling score, capillary refill time [CRT], toe-to-room gradient temperature) were recorded before, 5 min and 2 h after tracheal intubation (TI). Post intubation hemodynamic instability (PIHI) was defined as any hemodynamic event requiring therapeutic intervention. Results During 1 year, 120 patients were included, mainly male (59%) with a median age of 68 [57–77]. The median SOFA score and SAPS II were 6 [4–9] and 47 [37–63], respectively. The main indications for tracheal intubation were hypoxemia (51%), hypercapnia (13%), and coma (29%). In addition, 48% of patients had sepsis and 16% septic shock. Fifty-one (42%) patients develop PIHI. Univariate analysis identified several baseline factors associated with PIHI, including norepinephrine prior to TI, sepsis, tachycardia, fever, higher SOFA and high SAPSII score, mottling score ≥ 3, high lactate level and prolonged knee CRT. By contrast, mean arterial pressure, baseline cardiac index, and ejection fraction were not different between PIHI and No-PIHI groups. After adjustment on potential confounders, the mottling score was associated with a higher risk for PIHI (adjusted OR: 1.84 [1.21–2.82] per 1 point increased; p = 0.005). Among both global haemodynamics and tissue perfusion parameters, baseline mottling score was the best predictor of PIHI (AUC: 0.72 (CI 95% [0.62–0.81]). Conclusions In non-selected critically ill patients requiring invasive mechanical ventilation, tissue hypoperfusion parameters, especially the mottling score, could be helpful to predict PIHI. |
| first_indexed | 2024-12-12T00:38:25Z |
| format | Article |
| id | doaj.art-02fe61b83caf43598f7a6fa21e6c3e98 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-12T00:38:25Z |
| publishDate | 2022-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-02fe61b83caf43598f7a6fa21e6c3e982022-12-22T00:44:18ZengSpringerOpenAnnals of Intensive Care2110-58202022-07-011211810.1186/s13613-022-01043-3Peripheral tissue hypoperfusion predicts post intubation hemodynamic instabilityVincent Dubée0Geoffroy Hariri1Jérémie Joffre2Julien Hagry3Lisa Raia4Vincent Bonny5Paul Gabarre6Sebastien Ehrminger7Naike Bigé8Jean-Luc Baudel9Bertrand Guidet10Eric Maury11Guillaume Dumas12Hafid Ait-Oufella13Service de Maladies Infectieuses et Tropicales, CHU AngersAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAssistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de réanimation médicaleAbstract Background Tracheal intubation and invasive mechanical ventilation initiation is a procedure at high risk for arterial hypotension in intensive care unit. However, little is known about the relationship between pre-existing peripheral microvascular alteration and post-intubation hemodynamic instability (PIHI). Methods Prospective observational monocenter study conducted in an 18-bed medical ICU. Consecutive patients requiring tracheal intubation were eligible for the study. Global hemodynamic parameters (blood pressure, heart rate, cardiac function) and tissue perfusion parameters (arterial lactate, mottling score, capillary refill time [CRT], toe-to-room gradient temperature) were recorded before, 5 min and 2 h after tracheal intubation (TI). Post intubation hemodynamic instability (PIHI) was defined as any hemodynamic event requiring therapeutic intervention. Results During 1 year, 120 patients were included, mainly male (59%) with a median age of 68 [57–77]. The median SOFA score and SAPS II were 6 [4–9] and 47 [37–63], respectively. The main indications for tracheal intubation were hypoxemia (51%), hypercapnia (13%), and coma (29%). In addition, 48% of patients had sepsis and 16% septic shock. Fifty-one (42%) patients develop PIHI. Univariate analysis identified several baseline factors associated with PIHI, including norepinephrine prior to TI, sepsis, tachycardia, fever, higher SOFA and high SAPSII score, mottling score ≥ 3, high lactate level and prolonged knee CRT. By contrast, mean arterial pressure, baseline cardiac index, and ejection fraction were not different between PIHI and No-PIHI groups. After adjustment on potential confounders, the mottling score was associated with a higher risk for PIHI (adjusted OR: 1.84 [1.21–2.82] per 1 point increased; p = 0.005). Among both global haemodynamics and tissue perfusion parameters, baseline mottling score was the best predictor of PIHI (AUC: 0.72 (CI 95% [0.62–0.81]). Conclusions In non-selected critically ill patients requiring invasive mechanical ventilation, tissue hypoperfusion parameters, especially the mottling score, could be helpful to predict PIHI.https://doi.org/10.1186/s13613-022-01043-3IntubationHemodynamicMottlingTissue perfusionOutcome |
| spellingShingle | Vincent Dubée Geoffroy Hariri Jérémie Joffre Julien Hagry Lisa Raia Vincent Bonny Paul Gabarre Sebastien Ehrminger Naike Bigé Jean-Luc Baudel Bertrand Guidet Eric Maury Guillaume Dumas Hafid Ait-Oufella Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability Annals of Intensive Care Intubation Hemodynamic Mottling Tissue perfusion Outcome |
| title | Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability |
| title_full | Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability |
| title_fullStr | Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability |
| title_full_unstemmed | Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability |
| title_short | Peripheral tissue hypoperfusion predicts post intubation hemodynamic instability |
| title_sort | peripheral tissue hypoperfusion predicts post intubation hemodynamic instability |
| topic | Intubation Hemodynamic Mottling Tissue perfusion Outcome |
| url | https://doi.org/10.1186/s13613-022-01043-3 |
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