Impact of Interventions on Peri-Intubation Hypoxemia and Hypotension in Critically Ill Patients:Systematic Review and Meta-Analysis

Introduction: Emergent endotracheal intubation is common in critically ill patients. Underlying pathophysiologic derangements puts these patients at increased risk of peri-intubation major adverse events (MAE) and have been associated with higher morbidity and mortality. Investigating the impact of interventions in the peri-intubation period on the rate of peri-intubation hypoxemia and hypotension can help improve management of emergent airways. Methods: We searched PubMed, Embase, and Scopus databases from their beginning through April 2024 to identify randomized controlled trials (RCT) evaluating interventions to prevent peri-intubation hypoxemia and hypotension. Random-effects meta-analysis was used for the outcomes of peri-intubation hypoxemia and hypotension. We used the Cochrane risk-of-bias tool and Cochrane Q-statistic and I2 to assess the quality and heterogeneity of the included studies, respectively. Results: We included 16 RCTs included in our analysis with a total of 7,778 patients. All studies reported incidences of peri-intubation hypoxemia, and 11 studies reported rates of hypotension. One study had some concern of bias; otherwise all others were found to have low risk of bias. The examined interventions were associated with a 25% reduction in rates of hypoxemia (OR 0.748, 95% CI 0.566 - 0.988, P = .04). The subgroup of preoxygenation techniques showed a 63% reduction in rates of hypoxemia (OR 0.37, 95% CI 0.23 - 0.61, P .001). Interventions to prevent hypotension were not associated with a significant decrease in rates of peri-intubation hypotension (OR 0.848, CI 0.676 - 1.063, P = .15). Conclusion: Preoxygenation interventions, in the form of noninvasive ventilation, are associated with lower odds of hypoxemia in the peri-intubation period. More research is needed to determine whether interventions can be successful at preventing cardiovascular collapse.