Contributor: Ricky Dhaliwal, MD

Educational Pearls:

• Hypotension in patients requiring intubation should be resuscitated as much as possible
• While intubating, the negative inspiratory pressure goes away decreasing cardiac preload and worsening hypotension
• Phenylephrine can be given via push doses to increase blood pressure from alpha agonism
• For sedation, avoid propofol with hypotension and opt for etomidate or ketamine

References

April MD, Arana A, Schauer SG, et al. Ketamine Versus Etomidate and Peri-intubation Hypotension: A National Emergency Airway Registry Study. Acad Emerg Med. 2020;27(11):1106-1115. doi:10.1111/acem.14063

Panchal AR, Satyanarayan A, Bahadir JD, Hays D, Mosier J. Efficacy of Bolus-dose Phenylephrine for Peri-intubation Hypotension. J Emerg Med. 2015;49(4):488-494. doi:10.1016/j.jemermed.2015.04.033

Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multi-center study. Crit Care Med. 2006;34:2355–61.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

*********************