Avoidance of post-intubation arterial hypotension with push-dose metaraminol: a multicentre retrospective cohort study (ARAMAN study).

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.