3,423 Emergency Tracheal Intubations at a University Hospital Airway Outcomes and Complications
3,423 Emergency Tracheal Intubations at a University Hospital Airway Outcomes and Complications
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DOI：
10.1097/aln.0b013e318201c415
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发表时间：
2011-01-01
期刊：
影响因子：
8.8
通讯作者：
Kheterpal, Sachin
中科院分区：
文献类型：
--
作者：
Martin, Lizabeth D.;Mhyre, Jill M.;Kheterpal, Sachin
背景：关于紧急非手术插管的结果数据有限。目前的研究采用大型观察数据集进行，以评估插管困难的发生率和并发症发生率，并确定该情况下并发症的预测因素。方法：对 2001 年 12 月 5 日至 2009 年 7 月 6 日在我们的三级医疗机构进行的成人非手术室紧急插管进行了回顾。前瞻性定义的数据点包括一天中的时间、地点、主治医生在场、尝试次数、直接喉镜检查、辅助使用、药物和并发症。在我们机构，接受过至少 24 个月麻醉培训的高级住院医师是所有紧急气道请求的第一响应者。主要结局是复合气道并发症变量，包括误吸、食管插管、牙齿损伤或气胸。结果：共识别出 3,423 例急诊非手术室气道管理病例。插管困难发生率为10.3%。并发症发生率为 4.2%：误吸 2.8%；食管插管，1.3%；牙齿损伤，0.2%；气胸，0.1%。 12.4% 的病例使用探条导引器。在住院医师进行的 2,284 次插管中，复合并发症结果的独立预测因素如下：三次或多次插管尝试（比值比，6.7；95% CI，3.2-14.2）、III 或 IV 级视图（比值比，1.9；95% CI，1.1-3.5）、普通护理楼层位置（比值比，1.9；95%） CI，1.2-3.0）和急诊科地点（比值比，4.7；95% CI，1.1-20.4）。结论：在紧急非手术插管期间，特定的临床情况与气道并发症风险增加相关，并且可能为分配有经验的急救人员提供起点。
Background: There are limited outcome data regarding emergent nonoperative intubation. The current study was undertaken with a large observational dataset to evaluate the incidence of difficult intubation and complication rates and to determine predictors of complications in this setting.Methods: Adult nonoperating room emergent intubations at our tertiary care institution from December 5, 2001 to July 6, 2009 were reviewed. Prospectively defined data points included time of day, location, attending physician presence, number of attempts, direct laryngoscopy view, adjuvant use, medications, and complications. At our institution, a senior resident with at least 24 months of anesthesia training is the first responder for all emergent airway requests. The primary outcome was a composite airway complication variable that included aspiration, esophageal intubation, dental injury, or pneumothorax.Results: A total of 3,423 emergent nonoperating room airway management cases were identified. The incidence of difficult intubation was 10.3%. Complications occurred in 4.2%: aspiration, 2.8%; esophageal intubation, 1.3%; dental injury, 0.2%; and pneumothorax, 0.1%. A bougie introducer was used in 12.4% of cases. Among 2,284 intubations performed by residents, independent predictors of the composite complication outcome were as follows: three or more intubation attempts (odds ratio, 6.7; 95% CI, 3.2-14.2), grade III or IV view (odds ratio, 1.9; 95% CI, 1.1-3.5), general care floor location (odds ratio, 1.9; 95% CI, 1.2-3.0), and emergency department location (odds ratio, 4.7; 95% CI, 1.1-20.4).Conclusions: During emergent nonoperative intubation, specific clinical situations are associated with an increased risk of airway complication and may provide a starting point for allocation of experienced first responders.