Current practices and safety of medication use during rapid sequence intubation
Current practices and safety of medication use during rapid sequence intubation
复制标题
DOI：
10.1016/j.jcrc.2018.01.017
复制
发表时间：
2018-06-01
影响因子：
3.7
通讯作者：
Khadem, Tina
中科院分区：
文献类型：
--
作者：
Groth, Christine M.;Acquisto, Nicole M.;Khadem, Tina
目的：通过提供者/地点描述快速序列插管（RSI）期间和之后立即的药物实践，并评估药物不良事件。材料和方法：这是一项多中心、观察性、横断面研究，研究对象为成人和儿童重症监护病房和急诊科患者，研究时间为首次插管前后24小时。共纳入来自34个地理位置不同的机构的404例患者（平均年龄58 ± 22岁，男性59%，儿科8%）。在RSI期间，分别有21%、87%和77%接受了预诱导、诱导和麻痹。不同类型的供应商在药物使用方面存在显著差异。58%的脓毒症患者服用依托咪酯，但与肾上腺功能不全无关。氯胺酮与RSI后低血压相关[RR = 1.78（1.36-2.35）]，创伤性脑损伤/卒中的使用率较低（1.5%）。67%的基线心动过缓患者给予琥珀胆碱，与RSI后心动过缓显著相关[RR = 1.81（1.11-2.94）]。另外13%的琥珀胆碱有禁忌症。镇静的做法后RSI是不符合目前的实践指南，大多数接受非去极化麻痹没有收到足够的镇静post-RSI.Conclusions：药物治疗的做法在RSI不同的供应商和药物往往使用不当。在RSI期间有机会优化药物使用。(C)2018爱思唯尔公司All rights reserved.
Purpose: Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events.Materials and methods: This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation.Results: A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 +/- 22 years, males 59%, pediatric 8%). During RSI, 21%, 87%, and 77% received pre-induction, induction, and paralysis, respectively. Significant differences in medication use by provider type were seen. Etomidate was administered to 58% with sepsis, but was not associated with adrenal insufficiency. Ketamine was associated with hypotension post-RSI [RR = 1.78 (1.36-2.35)] and use was low with traumatic brain injury/stroke (1.5%). Succinylcholine was given to 67% of patients with baseline bradycardia and was significantly associated with bradycardia post-RSI [RR = 1.81 (1.11-2.94)]. An additional 13% given succinylcholine had contraindications. Sedation practices post-RSI were not consistent with current practice guidelines and most receiving a non-depolarizing paralytic did not receive adequate sedation post-RSI.Conclusions: Medication practices during RSI vary amongst provider and medications are often used inappropriately. There is opportunity for optimization of medication use during RSI. (C) 2018 Elsevier Inc. All rights reserved.