Heart & lung : the journal of critical care · 2026
Avoidance of post-intubation arterial hypotension with push-dose metaraminol: a multicentre retrospective cohort study (ARAMAN study).
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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da Silveira Fernando, Nedel Wagner, Tonietto Tiago Antonio, Vargas Taiani, Marin Luiz Gustavo, Marques Leonardo da Silva, Fendt Lúcia Costa Cabral, Felice Vinicius Brenner, Lisboa Thiago Costa
Аннотация
BACKGROUND: Post-intubation arterial hypotension is frequent among septic ICU patients and may contribute to worse outcomes. Whether prophylactic push-dose metaraminol can reduce the incidence of arterial hypotension during orotracheal intubation remains uncertain.
OBJECTIVES: To evaluate whether prophylactic push-dose metaraminol is associated with a reduction in arterial hypotension at the end of orotracheal intubation in septic ICU patients receiving fentanyl, propofol and rocuronium.
METHODS: This multicentre retrospective cohort study was conducted in three intensive care units in Brazil. Adults with presumed or confirmed sepsis requiring invasive mechanical ventilation were included. Patients receiving push-dose metaraminol (PDP group) immediately before or during intubation were compared with those not receiving a push-dose metaraminol (no-PDP group). The primary outcome was post-intubation arterial hypotension at the end of intubation. Secondary outcomes included noradrenaline requirement at 1 and 6 h, fluid balance, organ dysfunction, adverse events and peri‑intubation cardiac arrest.
RESULTS: A total of 349 patients were included, of whom 171 (49%) received push-dose metaraminol. Post-intubation hypotension occurred less often in the PDP group (21.1%) than in the no-PDP group (49.4%; OR 0.27, 95% CI 0.17-0.43; p < 0.01). Noradrenaline use at 1 hour was lower in the PDP group (43.8%vs 58.2%; OR 0.56, 95% CI 0.36-0.85; p < 0.01). There were no significant differences in 7-day and 28-day mortality. Adverse events were comparable.
CONCLUSIONS: In septic ICU patients, prophylactic push-dose metaraminol during orotracheal intubation was associated with lower post-intubation hypotension and reduced early vasopressor requirement, without increased adverse events.
OBJECTIVES: To evaluate whether prophylactic push-dose metaraminol is associated with a reduction in arterial hypotension at the end of orotracheal intubation in septic ICU patients receiving fentanyl, propofol and rocuronium.
METHODS: This multicentre retrospective cohort study was conducted in three intensive care units in Brazil. Adults with presumed or confirmed sepsis requiring invasive mechanical ventilation were included. Patients receiving push-dose metaraminol (PDP group) immediately before or during intubation were compared with those not receiving a push-dose metaraminol (no-PDP group). The primary outcome was post-intubation arterial hypotension at the end of intubation. Secondary outcomes included noradrenaline requirement at 1 and 6 h, fluid balance, organ dysfunction, adverse events and peri‑intubation cardiac arrest.
RESULTS: A total of 349 patients were included, of whom 171 (49%) received push-dose metaraminol. Post-intubation hypotension occurred less often in the PDP group (21.1%) than in the no-PDP group (49.4%; OR 0.27, 95% CI 0.17-0.43; p < 0.01). Noradrenaline use at 1 hour was lower in the PDP group (43.8%vs 58.2%; OR 0.56, 95% CI 0.36-0.85; p < 0.01). There were no significant differences in 7-day and 28-day mortality. Adverse events were comparable.
CONCLUSIONS: In septic ICU patients, prophylactic push-dose metaraminol during orotracheal intubation was associated with lower post-intubation hypotension and reduced early vasopressor requirement, without increased adverse events.