Incidence, Clinical Outcomes, and Factors Associated With Post-intubation Hypotension Among Critically Ill Patients Undergoing Emergency Endotracheal Intubation: A Retrospective Observational Study.

Background Post-intubation hypotension (PIH) is a common and clinically significant complication of emergency airway management in critically ill patients and is associated with adverse short-term outcomes. Objective The objective of this study was to determine the incidence, clinical outcomes, and factors associated with post-intubation hypotension among critically ill adults undergoing emergency endotracheal intubation. Methodology This retrospective observational study was conducted at Mayo Hospital, Lahore, Pakistan. Medical records of 234 adult patients who underwent emergency endotracheal intubation between March 2023 to March 2026 were reviewed. PIH was defined as systolic blood pressure <90 mmHg, mean arterial pressure <65 mmHg, or a ≥20% reduction in systolic blood pressure from the pre-intubation baseline within 30 minutes after successful intubation. Multivariable logistic regression was performed to identify factors independently associated with PIH. Results PIH occurred in 68 of 234 patients (29.1%). Patients with PIH were significantly older and had higher Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) score, and Shock Index values than those without PIH. On multivariable analysis, increasing age (adjusted OR (AOR) 1.03, 95% CI 1.01-1.06; p = 0.011), chronic kidney disease (AOR 2.08, 95% CI 1.01-4.29; p = 0.047), sepsis (AOR 2.64, 95% CI 1.38-5.05; p = 0.003), higher APACHE II score (AOR 1.11, 95% CI 1.04-1.18; p = 0.001), elevated Shock Index (AOR 3.42, 95% CI 1.74-6.74; p < 0.001), ketamine use compared with etomidate (AOR 1.89, 95% CI 1.01-3.53; p = 0.045), and difficult airway (AOR 2.27, 95% CI 1.07-4.83; p = 0.033) were independently associated with PIH. PIH was also associated with higher vasopressor requirement, longer mechanical ventilation and ICU and hospital stays, increased AKI, and higher ICU and in-hospital mortality. Conclusion PIH occurred in nearly one-third of critically ill adults undergoing emergency endotracheal intubation and was associated with worse short-term clinical outcomes. Older age, sepsis, chronic kidney disease, higher APACHE II score, elevated Shock Index, ketamine use, and difficult airway were independently associated with PIH. These findings support early recognition of patients at increased risk and warrant prospective multicentre studies to determine whether standardized peri-intubation strategies can reduce PIH and improve outcomes.