Post-intubation hypotension risk factors in patients with COVID-19 undergoing endotracheal intubation in the emergency department: A prospective observational study

Introduction: Acute respiratory distress syndrome, a severe manifestation of COVID-19, prompts the critical intervention of endotracheal intubation (ETI). However, ETI is associated with complications, notably post-intubation hypotension (PIH), linked to an increased adverse prognosis. Our purpose was to investigate risk factors for PIH in COVID-19 patients in the emergency department (ED). Methods: This observational study was conducted at the Afzalipour Hospital, Iran. Adult COVID-19 patients undergoing ETI were included, with data collected on demographic variables, medical history, and hemodynamic parameters. PIH was defined as the occurrence of any of the following: reduction of systolic blood pressure (SBP) to 90 mmHg or less; reduction of mean arterial pressure (MAP) to 65 mmHg or less; reduction of SBP by at least 20% of the initial value; or the need for vasopressor support during the 30 min after intubation. Results: Among 145 patients, the mortality rate was 82.7%, and PIH occured in 22.7%. Univariate analysis revealed associations between PIH and initial SBP (SBP-0) and initial MAP. Multivariable regression revealed that each 1 mmHg decrease in SBP-0 increased the risk of PIH by 5%. Patients with SBP-0 of less than 116 mmHg had a PIH odds ratio of 4.1. A history of hypertension (HTN) or ischemic heart disease (IHD) increased the likelihood of PIH sixfold. The receiver operating characteristic curves for SBP-0 had an area under the curve (AUC) of 0.67 (95% CI: 0.54-0.79), lower than the AUC of 0.77 (95% CI: 0.64-0.86) for the model incorporating SBP-0, history of HTN or IHD, and total severity score. Despite this, the Z score comparing the AUCs of SBP-0 and the multivariable model did not indicate a statistically significant difference. Conclusions: History of HTN or IHD, as well as low SBP-0, are independently associated with an increased risk of PIH in COVID-19 patients.