Peri-intubation Cardiovascular Collapse During Emergency Airway Management.

IF 3 Q2 RESPIRATORY SYSTEM

Pulmonary Therapy Pub Date : 2025-10-16 DOI:10.1007/s41030-025-00326-x

Samuel I Garcia, Nathan J Smischney, Benjamin J Sandefur, Jacopo D'Andria Ursoleo, Diana J Kelm, Patrick M Wieruszewski

{"title":"Peri-intubation Cardiovascular Collapse During Emergency Airway Management.","authors":"Samuel I Garcia, Nathan J Smischney, Benjamin J Sandefur, Jacopo D'Andria Ursoleo, Diana J Kelm, Patrick M Wieruszewski","doi":"10.1007/s41030-025-00326-x","DOIUrl":null,"url":null,"abstract":"<p><p>Emergency airway management is a lifesaving procedure but can be associated with significant risks, including hypoxia, hypotension, cardiac arrest, and death. Peri-intubation hypotension, reported in ≥ 40% of cases, is strongly associated with increased morbidity and mortality. While clinical guidelines emphasize the importance of preoxygenation and hemodynamic optimization prior to intubation, the latter remains poorly defined, with limited available data to guide evidence-based strategies to mitigate cardiovascular collapse during rapid sequence intubation. This review synthesizes current knowledge on the epidemiology, risk factors, and pathophysiology of peri-intubation hemodynamic deterioration. We review targeted strategies for hemodynamic optimization of physiologic parameters before intubation. These include volume expansion with fluid resuscitation, vasopressor utilization, selection of pharmacologic agents, invasive hemodynamic monitoring, and advanced preoxygenation techniques. In selected high-risk patients, we also discuss the potential role of extracorporeal membrane oxygenation as an adjunctive or rescue therapy. Our goal is to provide airway specialists with a comprehensive framework for mitigating cardiovascular collapse during emergent airway management and to stimulate further research into this high-risk and understudied domain.</p>","PeriodicalId":20919,"journal":{"name":"Pulmonary Therapy","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pulmonary Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s41030-025-00326-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Emergency airway management is a lifesaving procedure but can be associated with significant risks, including hypoxia, hypotension, cardiac arrest, and death. Peri-intubation hypotension, reported in ≥ 40% of cases, is strongly associated with increased morbidity and mortality. While clinical guidelines emphasize the importance of preoxygenation and hemodynamic optimization prior to intubation, the latter remains poorly defined, with limited available data to guide evidence-based strategies to mitigate cardiovascular collapse during rapid sequence intubation. This review synthesizes current knowledge on the epidemiology, risk factors, and pathophysiology of peri-intubation hemodynamic deterioration. We review targeted strategies for hemodynamic optimization of physiologic parameters before intubation. These include volume expansion with fluid resuscitation, vasopressor utilization, selection of pharmacologic agents, invasive hemodynamic monitoring, and advanced preoxygenation techniques. In selected high-risk patients, we also discuss the potential role of extracorporeal membrane oxygenation as an adjunctive or rescue therapy. Our goal is to provide airway specialists with a comprehensive framework for mitigating cardiovascular collapse during emergent airway management and to stimulate further research into this high-risk and understudied domain.

查看原文本刊更多论文

急诊气道管理中的围插管期心血管衰竭。

紧急气道管理是一种挽救生命的程序，但可能存在显著的风险，包括缺氧、低血压、心脏骤停和死亡。据报道，≥40%的病例中出现围插管期低血压，与发病率和死亡率增加密切相关。虽然临床指南强调插管前预充氧和血流动力学优化的重要性，但后者仍然定义不清，现有数据有限，无法指导以证据为基础的策略，以减轻快速顺序插管期间的心血管衰竭。本文综述了目前在流行病学、危险因素和插管期血流动力学恶化的病理生理学方面的知识。我们回顾了插管前生理参数血流动力学优化的针对性策略。这些包括液体复苏的容量扩张、血管加压剂的使用、药物的选择、有创血流动力学监测和先进的预充氧技术。在选定的高危患者中，我们也讨论了体外膜氧合作为辅助或抢救治疗的潜在作用。我们的目标是为气道专家提供一个在紧急气道管理过程中减轻心血管衰竭的综合框架，并促进对这一高风险和研究不足领域的进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pulmonary Therapy Medicine-Pulmonary and Respiratory Medicine

CiteScore

5.20

自引率

3.30%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Pulmonary Therapy is an international, open access, peer-reviewed (single-blind), and rapid publication journal. The scope of the journal is broad and will consider all scientifically sound research from pre-clinical, clinical (all phases), observational, real-world, and health outcomes research around the use of pulmonary therapies, devices, and surgical techniques. Areas of focus include, but are not limited to: asthma; chronic obstructive pulmonary disease; idiopathic pulmonary fibrosis; pulmonary hypertension; cystic fibrosis; lung cancer; respiratory tract disorders; allergic rhinitis and other respiratory allergies; influenza, pneumococcal infection, respiratory syncytial virus and other respiratory infections; and inhalers and other device therapies. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/series, trial protocols and short communications such as commentaries and editorials. Pulmonary Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. Rapid Publication The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of pulmonary therapies. Open Access All articles published by Pulmonary Therapy are open access. Personal Service The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning authors will always have an editorial contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research. Digital Features and Plain Language Summaries Pulmonary Therapy offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by key summary points, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article. The journal also provides the option to include various types of digital features including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations. All additional features are peer reviewed to the same high standard as the article itself. If you consider that your paper would benefit from the inclusion of a digital feature, please let us know. Our editorial team are able to create high-quality slide decks and infographics in-house, and video abstracts through our partner Research Square, and would be happy to assist in any way we can. For further information about digital features, please contact the journal editor (see ‘Contact the Journal’ for email address), and see the ‘Guidelines for digital features and plain language summaries’ document under ‘Submission guidelines’. For examples of digital features please visit our showcase page https://springerhealthcare.com/expertise/publishing-digital-features/ Publication Fees Upon acceptance of an article, authors will be required to pay the mandatory Rapid Service Fee of €4500/ $5100/ £3650. The journal will consider fee discounts and waivers for developing countries and this is decided on a case by case basis. Peer Review Process Upon submission, manuscripts are assessed by the editorial team to ensure they fit within the aims and scope of the journal and are also checked for plagiarism. All suitable submissions are then subject to a comprehensive single-blind peer review. Reviewers are selected based on their relevant expertise and publication history in the subject area. The journal has an extensive pool of editorial and advisory board members who have been selected to assist with peer review based on the afore-mentioned criteria. At least two extensive reviews are required to make the editorial decision, with the exception of some article types such as Commentaries, Editorials, and Letters which are generally reviewed by one member of the Editorial Board. Where reviewer recommendations are conflicted, the editorial board will be contacted for further advice and a presiding decision. Manuscripts are then either accepted, rejected or authors are required to make major or minor revisions (both reviewer comments and editorial comments may need to be addressed). Once a revised manuscript is re-submitted, it is assessed along with the responses to reviewer comments and if it has been adequately revised it will be accepted for publication. Accepted manuscripts are then copyedited and typeset by the production team before online publication. Appeals against decisions following peer review are considered on a case-by-case basis and should be sent to the journal editor. Preprints We encourage posting of preprints of primary research manuscripts on preprint servers, authors’ or institutional websites, and open communications between researchers whether on community preprint servers or preprint commenting platforms. Posting of preprints is not considered prior publication and will not jeopardize consideration in our journals. Authors should disclose details of preprint posting during the submission process or at any other point during consideration in one of our journals. Once the manuscript is published, it is the author’s responsibility to ensure that the preprint record is updated with a publication reference, including the DOI and a URL link to the published version of the article on the journal website. Please follow the link for further information on preprint sharing: https://www.springer.com/gp/authors-editors/journal-author/journal-author-helpdesk/submission/1302#c16721550 Copyright Pulmonary Therapy''s content is published open access under the Creative Commons Attribution-Noncommercial License, which allows users to read, copy, distribute, and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited. The author assigns the exclusive right to any commercial use of the article to Springer. For more information about the Creative Commons Attribution-Noncommercial License, click here: http://creativecommons.org/licenses/by-nc/4.0. Contact For more information about the journal, including pre-submission enquiries, please contact christopher.vautrinot@springer.com.