Predicting Cardiovascular Collapse in Critically Ill Patients During Intubation Induction: A Prospective Observational Study.
Ömer Emgin, Gamze Taşkan, Aytuğ Yıldız, İmren Taşkıran, Engin Haftacı, Adnan Ata, Mehmet Yılmaz
Medicina (Kaunas, Lithuania) January 15, 2026 DOI: 10.3390/medicina62010177 via PubMed
Summary
AI-generated from the abstractAmong 130 intensive care unit patients, 47.7% experienced peri-intubation cardiovascular collapse (PIC). Age Shock Index (Age-SI) had the highest predictive accuracy for PIC. Ketamine was associated with a reduced risk of PIC (odds ratio 0.161), while propofol (odds ratio 2.962), older age, higher lactate, and higher Diastolic Shock Index were independent risk factors. ICU mortality was markedly higher in patients who developed PIC (74.2% vs. 20.6%). These findings support using Age-SI and other shock indices for risk assessment and selecting ketamine over propofol to lower PIC risk during ICU intubation.
Study at a glance
| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 130 |
| Population | Intensive care unit patients undergoing intubation |
| Interventions | ketamine propofol |
| Topics | Ketamine |
| Keywords | Intensive care unit Peri-intubation cardiovascular collapse Propofol Shock indices |
| Key finding | Ketamine reduced the risk of peri-intubation cardiovascular collapse, while propofol, older age, higher lactate, and higher Diastolic Shock Index increased the risk. |
Abstract
Background and Objectives: The study aimed to evaluate the predictive significance of Shock Indices and induction agents in predicting the risk of Peri-Intubation Cardiovascular Collapse (PIC) during intubation in the ICU. Materials and Methods: A total of 130 patients were analyzed in the study after dividing them into 2 groups based on the definition of PIC as Patients with PIC and Non-PIC Patients. PIC was defined as the detection of at least SBP 90 mmHg with >15 mL/kg crystalloid fluid infusion, or development of cardiac arrest. The relationship between Shock Index (SI), Diastolic Shock Index (DSI), Modified Shock Index (MSI), Age Shock Index (Age-SI), and induction agents (ketamine, propofol) and PIC was evaluated. Results: The PIC was detected in 62 patients (47.7%). Age-SI showed the highest predictive performance (AUC = 0.686, p < 0.001). Ketamine provided a protective effect (OR = 0.161, p = 0.003). Propofol (OR = 2.962, p = 0.048), age (OR = 1.065, p = 0.002), lactate (OR = 1.265, p = 0.047), and DSI (OR = 2.300, p = 0.037) were identified as independent risk factors. ICU mortality was significantly higher in the PIC group (74.2% vs. 20.6%, p < 0.001). Conclusions: Age, lactate, DSI, and Age-SI are valuable predictive parameters for PIC. Ketamine reduces the risk of PIC, while propofol increases it. These results support evidence-based risk assessment and induction agent selection in ICU intubation protocols.