Predictive Value Of Hypotension Prediction Score For Hypotension After Emergency Tracheal Intubation

Objective Airway management is an important part of emergency medicine.Airway management in emergency departments is often urgent and unpredictable.Endotracheal intubation(ETI)is a basic operation in emergency departments to rescue critically ill patients.ETI itself,as an invasive operation,will cause a variety of complications.In addition,patients in the emergency department are complicated and changeable,the emergency environment is chaotic,and there are many emergencies.Unplanned ETI is often required urgently,which makes ETI complications occur.rate further increased.Post-intubation hypotension(Post Intubation Hypotension PIH)is a relatively common complication,which seriously affects the patient’s condition and prognosis.However,there is currently no unified standard to predict the occurrence of PIH.Emergency physicians often judge the occurrence of PIH empirically by monitoring the vital signs of patients.The Hypotension Prediction Score(HYPS)is the latest PIH prediction score.The purpose of this study is to evaluate the predictive value of the HYPS scoring system for the occurrence of PIH in emergency departments,and to provide emergency physicians with objective risk basis for the occurrence of PIH,and to provide timely evidence for the occurrence of PIH.Assess the patient’s condition and give early clinical intervention to reduce or avoid the occurrence of PIH.Methods A retrospective study was conducted to 257 patients who met the screening conditions in the Affiliated Hospital of Hebei University from July 2018 to July 2021.The basic information,general life signs,clinical history and outcome after intubation were collected.The patients were divided into non PIH group and PIH group according to whether hypotension occurred after intubation.The observation objects were scored according to the HYPS scoring standard.They were divided into low-risk group(≤1.5),medium-risk group(2～10.5),high-risk group(11～18.5)and very high-risk group(≥19).SPSS 23.0 statistical software was used to analyze the observation indexes of the two groups of patients,and further logistic regression analysis was performed to screen out the independent risk factors of PIH in critically ill patients.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC),95%confidence interval(95%CI),sensitivity,specificity,Jordan index and the best cutoff value were calculated.P<0.05,with statistical significance.Results Among the 257 subjects included in the study,97(37.7%)were female,with an average age of 66.99±12.26 years,and 160(62.3%)were male,with an average age of 63.46±14.87 years.There were 154(59.9%)hypertensive patients,103(40.1%)non-hypertensive patients,and 48(18.7%)patients with PIH.In the measurement data,peripheral arterial oxygen saturation(91.25%±10.15%VS 87.46%±8.96%),systolic blood pressure(159.81±36.12mmHg VS 143.23±43.77mmHg),APACHE Ⅱ score(19.02±4.8 points VS 23.08±4.84 points),HYPS score(6.678±4.34 points VS 11.64±5.98 points),SI(0.66±0.25 points VS 0.81±0.37 points)were statistically significant(P<0.05),and age(66.69±16.12 years old VS 64.36±13.51 years old),respiratory rate(22.07±7.44 times/min VS 22.23±7.95 times/min),heart rate(99.55±24.06 times/min VS 105.08±27.92 times/min)were not statistically significant(P>0.05).History of heart failure,end-stage renal disease,hypovolemic shock,use of catecholamines in the enumeration data center was statistically significant(P<0.05),gender,coronary heart disease,history of COPD,liver cirrhosis,diabetes,respiratory failure,use of diuretics,The use of sedatives,hypoalbuminemia,and history of hypertension were not statistically significant.Compared with the non-PIH group,patients with PIH had higher respiratory rate,heart rate,APACHE Ⅱ score,HYPS score,and SI.With the increase of HYPS score,the incidence of PIH gradually increased,and the incidence of PIH in the very high-risk group was the highest,reaching 61.5%.Binary logistic regression analysis showed that peripheral arterial oxygen saturation and HYPS score were independent risk factors for the occurrence of PIH(P<0.05).The area under the HYPS curve calculated by the ROC curve was 0.753,the upper limit of the 95%confidence interval was 0.677,and the lower limit was 0.828.The area under the SI curve was 0.628,the standard error was 0.047,and the P value was 0.006<0.05,which was statistically significant.The upper limit of the 95%confidence interval was 0.537 and the lower limit was 0.720.It shows that the HYPS scoring system has a good predictive value for the occurrence of PIH.HYPS scores were more predictive of PIH than SI.When the HYPS is 9.5 points,it has the best specificity and sensitivity,and it has good predictive value for the occurrence risk of PIH.Conclusion 1.Patients with PIH have higher HYPS score than patients without PIH.With the increase of HYPS score,the possibility of PIH increases.2.Pulse oxygen and HYPS score are independent risk factors for PIH.When HYPS is 9.5,the specificity and sensitivity are the best,and the prediction ability of PIH is the best.3.Compared with SI,HYPS scoring system has good predictive value for the occurrence of PIH.