A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension
Background/Objectives: Peri-intubation hypotension is a known complication of endotracheal intubation. In the hospital setting, peri-intubation hypotension has been shown to increase hospital mortality and length of stay. The use of prophylactic vasopressors at the time of sedation induction to prev...
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MDPI AG
2024-12-01
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| author | Hollie Saunders Subekshya Khadka Rabi Shrestha Hassan Z. Baig Scott A. Helgeson |
| author_facet | Hollie Saunders Subekshya Khadka Rabi Shrestha Hassan Z. Baig Scott A. Helgeson |
| author_sort | Hollie Saunders |
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| description | Background/Objectives: Peri-intubation hypotension is a known complication of endotracheal intubation. In the hospital setting, peri-intubation hypotension has been shown to increase hospital mortality and length of stay. The use of prophylactic vasopressors at the time of sedation induction to prevent peri-intubation hypotension has been raised. This systematic review and meta-analysis aims to review the safety and efficacy of this practice. Methods: The study was fully registered with PROSPERO on 13 October 2022, and screening for eligibility was initiated on 20 September 2024. Randomized controlled trials, along with retrospective or prospective cohort studies, were included in the search. The terms “peri-intubation hypotension”, “vasopressors”, “intubation”, and “anesthesia induced hypotension” were used to search the title/summary in PubMed, Cochrane Library, and Google Scholar databases. An assessment of bias for each study was conducted using the Newcastle-Ottawa Quality Assessment Scale. The primary outcome was the rate of hypotension peri-intubation. Any complications secondary to hypotension or vasopressors were the secondary outcome. Results: We identified 13 studies, which were all randomized controlled studies, to include in the final analysis. The risk ratio for preventing peri-intubation hypotension was 1.6 (95% CI, 1.2–2.14) with the use of prophylactic phenylephrine while giving propofol versus no prophylactic vasopressors and 1.28 (95% CI 1.03–1.60) with the use of ephedrine. Conclusions: These findings suggest that in patients undergoing intubation in the operating room with propofol, prophylactic vasopressors given with induction for intubation decrease the odds of hypotension. |
| format | Article |
| id | doaj-art-4ebf5e6fb08441db888f658abb975b7b |
| institution | Kabale University |
| issn | 2079-9721 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diseases |
| spelling | doaj-art-4ebf5e6fb08441db888f658abb975b7b2025-01-24T13:29:13ZengMDPI AGDiseases2079-97212024-12-01131510.3390/diseases13010005A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation HypotensionHollie Saunders0Subekshya Khadka1Rabi Shrestha2Hassan Z. Baig3Scott A. Helgeson4Department of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL 32224, USADepartment of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL 32224, USADepartment of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL 32224, USADepartment of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL 32224, USADepartment of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL 32224, USABackground/Objectives: Peri-intubation hypotension is a known complication of endotracheal intubation. In the hospital setting, peri-intubation hypotension has been shown to increase hospital mortality and length of stay. The use of prophylactic vasopressors at the time of sedation induction to prevent peri-intubation hypotension has been raised. This systematic review and meta-analysis aims to review the safety and efficacy of this practice. Methods: The study was fully registered with PROSPERO on 13 October 2022, and screening for eligibility was initiated on 20 September 2024. Randomized controlled trials, along with retrospective or prospective cohort studies, were included in the search. The terms “peri-intubation hypotension”, “vasopressors”, “intubation”, and “anesthesia induced hypotension” were used to search the title/summary in PubMed, Cochrane Library, and Google Scholar databases. An assessment of bias for each study was conducted using the Newcastle-Ottawa Quality Assessment Scale. The primary outcome was the rate of hypotension peri-intubation. Any complications secondary to hypotension or vasopressors were the secondary outcome. Results: We identified 13 studies, which were all randomized controlled studies, to include in the final analysis. The risk ratio for preventing peri-intubation hypotension was 1.6 (95% CI, 1.2–2.14) with the use of prophylactic phenylephrine while giving propofol versus no prophylactic vasopressors and 1.28 (95% CI 1.03–1.60) with the use of ephedrine. Conclusions: These findings suggest that in patients undergoing intubation in the operating room with propofol, prophylactic vasopressors given with induction for intubation decrease the odds of hypotension.https://www.mdpi.com/2079-9721/13/1/5intubationhypotensionvasopressors |
| spellingShingle | Hollie Saunders Subekshya Khadka Rabi Shrestha Hassan Z. Baig Scott A. Helgeson A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension Diseases intubation hypotension vasopressors |
| title | A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension |
| title_full | A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension |
| title_fullStr | A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension |
| title_full_unstemmed | A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension |
| title_short | A Systematic Review and Meta-Analysis of Prophylactic Vasopressors for the Prevention of Peri-Intubation Hypotension |
| title_sort | systematic review and meta analysis of prophylactic vasopressors for the prevention of peri intubation hypotension |
| topic | intubation hypotension vasopressors |
| url | https://www.mdpi.com/2079-9721/13/1/5 |
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