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J Korean Soc Emerg Med > Volume 29(4); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(4): 358-363.
응급센터에서의 기관 삽관 후 저혈압을 예측하는 인자로서의 modified shock index의 유용성
장준성1, 이경미1 , 김인병1 , 김현종2 , 김정언1
1명지병원 응급의학과
2인제대학교 일산백병원 응급의학과
The usefulness of modified shock index for prediction of postintubation hypotension in emergency department
Junsung Jang1, Kyoungmi Lee1 , Inbyung Kim1 , Hyunjong Kim2 , Jungeon Kim1
1Department of Emergency Medicine, Myongji Hospital, Goyang, Korea
2Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
Correspondence  Jungeon Kim ,Tel: 031-810-7119, Fax: 031-969-0500, Email: jekim1229@naver.com,
Received: May 18, 2018; Revised: June 28, 2018   Accepted: July 22, 2018.  Published online: August 31, 2018.
Hypotension after emergent endotracheal intubation is a serious complication related to in-hospital mortality. We investigated factors including modified shock index to predict the development of hypotension after emergent intubation.
This retrospective observational study was conducted between January 2011 and December 2016. The study population included intubated patients among all medical patients admitted to the emergency department (ED) except for patients whose systolic blood pressure was below 90 mmHg at any time before intubation. The postintubation hypotension (PIH) groups were compared with the non-PIH group. The secondary outcome was in-hospital mortality.
A total of 285 patients were included in this study, of which 92 patients (32.3%) PIH. The age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; P=0.001), serum albumin level (OR, 0.62; 95% CI, 0.41-0.92; P=0.019), shock index (OR, 3.25; 95% CI, 1.26-8.38; P=0.015), and modified shock index (MSI) (OR, 2.18; 95% CI, 1.06-4.47; P=0.034) were more closely associated with PIH than any other factors. The average survival of the PIH group was significantly shorter than that of the non-PIH group (13.6±3.5 vs. 35.6±12.0, log-rank test P=0.019).
Overall, 32.3% of hemodynamically stable medical patients developed PIH in ED. MSI was associated with PIH.
Key words: Intubation; Hypotension; Risk factors; Mortality; Emergency medical services; Hospitals
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