Abstract
Background: In many hospitals, emergency physicians commonly initiate invasive positive-pressure
ventilation. Objectives: To review common patient- and ventilator-related factors
that can promote hemodynamic instability during and after endotracheal intubation.
Discussion: Venous return is proportional to mean systemic pressure (Pms) minus right
atrial pressure (Pra). Endotracheal intubation with positive-pressure ventilation
often reduces Pms while always increasing Pra, so venous return inevitably decreases,
resulting in hypotension in almost one-third of patients. This article reviews the
pathophysiology of respiratory failure, the basic circulatory physiology associated
with endotracheal intubation, and methods that may be helpful to reduce the frequency
of intubation-related hypotension. Conclusion: Although unproven, preventive measures
taken before, during, and after endotracheal intubation are likely to minimize the
frequency, magnitude, and duration of intubation-related hypotension.
Keywords
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Article info
Publication history
Published online: May 22, 2009
Accepted:
January 13,
2009
Received in revised form:
December 23,
2008
Received:
November 13,
2008
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
