Prophylactic Administration of Vasopressors Prior to Emergency Intubation in Critically Ill Patients: A Secondary Analysis of Two Multicenter Clinical Trials.
Prophylactic Administration of Vasopressors Prior to Emergency Intubation in Critically Ill Patients: A Secondary Analysis of Two Multicenter Clinical Trials.
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DOI：
10.1097/cce.0000000000000946
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发表时间：
2023-07
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低血压影响约40%接受紧急插管的危重患者，并与死亡风险增加相关。本研究的目的是检查预防性血管加压药给药与插管周围低血压发生率和其他临床结局之间的相关性。两项多中心随机临床试验的次要分析。预防性血管加压药给药的临床效果是使用一对一倾向匹配队列的患者和未使用预防性血管加压药的患者进行评估的。全美7个急诊室和17个重症监护室。2019年2月1日至2021年5月24日期间在研究中心接受紧急插管的1798例重症患者。没有。主要结局是插管周围低血压，定义为诱导至气管插管后2分钟之间发生的收缩压低于90 mm Hg。共有187例患者（10%）在插管前接受了预防性血管加压药。与未接受预防性血管加压药的患者相比，接受预防性血管加压药的患者年龄更大，急性生理学和慢性健康评估II评分更高，更有可能诊断为脓毒症，诱导前收缩压更低，更有可能在插管前持续输注血管加压药。在我们的倾向匹配队列中，预防性血管加压药给药与插管周围低血压风险降低（41% vs 32%; p = 0.08）或收缩压较基线变化（-12 vs -11 mm Hg; p = 0.66）无关。在我们的倾向匹配分析中，预防性血管加压药的使用与插管周围低血压的发生率较低无关。为了解决潜在的残余混杂因素，随机临床试验应检查预防性血管加压药给药对插管周围结局的影响。
Hypotension affects approximately 40% of critically ill patients undergoing emergency intubation and is associated with an increased risk of death. The objective of this study was to examine the association between prophylactic vasopressor administration and the incidence of peri-intubation hypotension and other clinical outcomes. A secondary analysis of two multicenter randomized clinical trials. The clinical effect of prophylactic vasopressor administration was estimated using a one-to-one propensity-matched cohort of patients with and without prophylactic vasopressors. Seven emergency departments and 17 ICUs across the United States. One thousand seven hundred ninety-eight critically ill patients who underwent emergency intubation at the study sites between February 1, 2019, and May 24, 2021. None. The primary outcome was peri-intubation hypotension defined as a systolic blood pressure less than 90 mm Hg occurring between induction and 2 minutes after tracheal intubation. A total of 187 patients (10%) received prophylactic vasopressors prior to intubation. Compared with patients who did not receive prophylactic vasopressors, those who did were older, had higher Acute Physiology and Chronic Health Evaluation II scores, were more likely to have a diagnosis of sepsis, had lower pre-induction systolic blood pressures, and were more likely to be on continuous vasopressor infusions prior to intubation. In our propensity-matched cohort, prophylactic vasopressor administration was not associated with reduced risk of peri-intubation hypotension (41% vs 32%; p = 0.08) or change in systolic blood pressure from baseline (–12 vs –11 mm Hg; p = 0.66). The administration of prophylactic vasopressors was not associated with a lower incidence of peri-intubation hypotension in our propensity-matched analysis. To address potential residual confounding, randomized clinical trials should examine the effect of prophylactic vasopressor administration on peri-intubation outcomes.