HYPOTENSION DURING EMERGENCY INTUBATION IN THE CRITICALLY ILL PATIENT
Keywords:
Intubation, Intratracheal. Hypotension. Critical Care. Airway Management. HemodynamicsAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0906
Abstract
Introduction: emergency intubation in critically ill adults was associated with a high burden of peri-intubation adverse events, with hemodynamic instability being the most frequent major event. Objective: to critically appraise contemporary evidence on intubation-related hypotension, its mechanisms, risk factors, preventive strategies, and association with clinical outcomes from the integrated perspective of internal medicine, critical care, and anesthesiology. Methods: a critical literature review with structured searching was conducted, prioritizing multicenter observational studies, randomized clinical trials, systematic reviews, and clinical practice guidelines published between 2008 and 2026. Results: cardiovascular instability occurred in roughly one fifth to nearly one half of emergency intubations and was associated with higher risks of cardiac arrest, organ dysfunction, and mortality. The most consistent predictors were pre-existing shock, severe hypoxemia, right ventricular dysfunction, repeated attempts, exposure to hemodynamically depressive induction agents, and inadequate pre-intubation physiological optimization. Routine fluid loading did not show consistent benefit in randomized trials, whereas selective early vasopressor use appeared more rational in vasoplegic patients or in those with low mean arterial pressure. Individualized choice of induction agent, intensified preoxygenation, first-pass success, and immediate post-intubation monitoring emerged as central preventive measures. Discussion: the problem was physiological and organizational rather than merely technical; therefore, hemodynamic preparation should be treated as part of the procedure itself. Conclusions: emergency intubation should be managed as a high-risk cardiovascular procedure. Phenotype-guided optimization before laryngoscopy likely provides greater value than universal empiric measures.
Keywords: Intubation, Intratracheal. Hypotension. Critical Care. Airway Management. Hemodynamics.
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