In this episode, I’ll discuss postintubation hypotension following rapid sequence intubation with full vs. reduced-dose induction agent.
One of the most common complications of rapid sequence intubation (RSI) in the setting of acutely ill patients in the emergency department (ED) is postintubation hypotension. While the cause of hypotension may be multi-factorial, the dose of sedative agent used is often implicated as a factor that contributes to postintubation hypotension (PIH).
A group of researchers recently published AJHP a health system–wide, retrospective cohort study looking at the incidence of PIH in patients receiving full-dose compared to reduced-dose induction agent for RSI in the ED.
The authors defined a reduced dose induction agent as ketamine at 1.25 mg/kg or less and etomidate at 0.2 mg/kg or less.
Just over 900 patients were included in the analysis, and about 5/6 of the patients received etomidate.
Only about 14% of the etomidate group were given a reduced dose but triple this rate were given a reduced dose in the ketamine group.
The authors found that the group with the highest rate of PIH were those who received full-dose ketamine for induction at 36.5%. This rate was was statistically significantly higher when compared to patients receiving reduced-dose ketamine at 16.7% and full-dose etomidate at 22.8%.
However, the full-dose ketamine group had the poorest baseline hemodynamics, and this confounds any interpretation that would suggest the dose of ketamine was related to the rate of PIH.
The authors concluded their results do not support the broad use of a reduced-dose induction agent for the purposes of lowering the risk of PIH.
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