The Incidence of Post-Intubation Hypotension in Trauma Patients after Etomidate Administration
MetadataShow full item record
BACKGROUND: Post-intubation hypotension (PIH) is found in up to 44% of patients emergently intubated in the ED. Etomidate is a popular agent used in rapid sequence induction (RSI) for emergency intubations due to its stable hemodynamic profile. The purpose of this study was to prospectively investigate the incidence of PIH in trauma patients requiring emergent intubation using etomidate as the induction agent. METHODS: All patients intubated in the emergency department (ED) who were induced using etomidate were prospectively recruited for this study. Serial vital signs were recorded just prior to RSI drug administration and every 5 minutes after for 20 minutes. RESULTS: 20 adult patients were recruited for this study over an 8-week period, 12 (80%) medical and 8 (89%) trauma. Each patient received an average dose of 22 mg. See Table 1 and Figure 1 a comparison of MAP changes observed in medical patients verses trauma patients just prior to the administration of RSI medications and at 5, 10, 15, and 20 minutes intervals. CONCLUSION: Etomidate can significantly reduce the MAP in trauma patients. One plausible explanation in the immediate post-intubation period is the reduced sympathetic stimulation that results once unconsciousness is induced. Critically ill trauma patients who require emergent intubation are likely to have concomitant injuries and are at risk for hemorrhagic shock or worsening cerebral injury from precipitous decreases in blood pressure. Resuscitative measures should be cautiously instituted to mitigate any adverse effects of hypoperfusion from PIH in these critically ill patients.