Retrospective cohort study reveals high accuracy of a predictive nomogram for post-intubation hypotension in emergency patients, indicating potential for targeted pre-emptive interventions.
Key Points
To develop and internally validate a nomogram-based clinical model to predict the risk of post-intubation hypotension among emergency department patients undergoing emergent oral endotracheal intubation.
Retrospective analysis of 748 consecutive emergency department patients undergoing emergent intubation, randomly assigned 7:3 into training and internal validation cohorts.
Used LASSO and multivariable logistic regression on peri-intubation clinical and laboratory parameters to select predictors and build the nomogram, evaluated with AUC-ROC, calibration, and decision curve analyses.
Post-intubation hypotension occurred in 19.5% (146/748) of patients within 30 minutes of intubation.
The final nomogram incorporated three independent variables—shock index, pulse pressure, and partial pressure of carbon dioxide—yielding an AUC-ROC of 0.790 in the training cohort and 0.805 in the validation cohort.
Risk stratification defined low-risk (incidence 5.8%), intermediate-risk (incidence 28.4%), and high-risk (incidence 52.0%) tiers with net clinical benefit between 1% and 51% threshold probabilities.