Propofol administration for induction is associated with peri-intubation instability in trauma critical care unit patients

Am J Surg. 2024 Dec:238:115858. doi: 10.1016/j.amjsurg.2024.115858. Epub 2024 Jul 23.

Abstract

Introduction: Peri-intubation hypotension is associated with increased hospital length of stay and morbidity. Propofol is associated with alterations in hemodynamics. We hypothesize that using propofol for induction leads to peri-intubation hypotension in trauma critical care patients.

Methods: Patients that underwent unplanned intubation in the trauma intensive care unit (TICU) were prospectively enrolled. Peri-intubation vitals and medications were recorded to assess hypotension within 10 ​min of intubation. Patients were divided into propofol (PROP) or other medication (OTR) groups.

Results: Data was complete for 69 patients; 31 PROP and 38 OTR. In OTR there was an 8.8-point (-21.1, 3.6) SBP decrease (p ​= ​0.159) and in PROP there was a 30.8-point (-45.6, -16.0) SBP decrease (p ​= ​0.0002) with significant increases in heart rate (HR) and shock index (SI) (HR p ​= ​0.001, SI p ​< ​0.0001).

Conclusion: In patients without hypotension prior to intubation, we observed a statistically significant drop in the patients' SBP with use of propofol. In trauma critical care unit patients, we recommend considering an induction medication for unplanned intubation other than propofol.

Keywords: Hemodynamics; Intubation; Propofol; Trauma.

MeSH terms

  • Adult
  • Aged
  • Anesthetics, Intravenous / administration & dosage
  • Critical Care / methods
  • Female
  • Humans
  • Hypotension* / etiology
  • Intensive Care Units*
  • Intubation, Intratracheal* / adverse effects
  • Male
  • Middle Aged
  • Propofol* / administration & dosage
  • Propofol* / adverse effects
  • Prospective Studies
  • Wounds and Injuries / complications
  • Wounds and Injuries / therapy

Substances

  • Propofol
  • Anesthetics, Intravenous