Emergency tracheal intubation: Complications associated with repeated laryngoscopic attempts
Emergency tracheal intubation: Complications associated with repeated laryngoscopic attempts
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DOI：
10.1213/01.ane.0000122825.04923.15
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发表时间：
2004-08-01
影响因子：
5.7
通讯作者：
Mort, TC
中科院分区：
文献类型：
--
作者：
Mort, TC
重复的常规气管插管尝试可能导致患者的发病率。患有心血管、肺、代谢、神经或创伤相关恶化的危重患者（n = 2833）被输入紧急插管质量改善数据库。根据一组与成功在手术室外气管插管所需尝试次数相关的定义变量，对气道和血流动力学相关并发症进行实践分析。随着喉镜检查次数的增加，气道相关并发症的发生率显著增加（< 2次对bb0.2次）：低氧血症（11.8%对70%）、胃内容物反流（1.9%对22%）、胃内容物误吸（0.8%对3%）、心动过缓（1.60%对21%）和心脏骤停（0.7%对110%；P < 0.001）。虽然可以预测，但该分析提供的数据证实喉镜尝试次数与气道和血流动力学不良事件的发生率相关。这些数据支持美国航空标准局困难气道管理工作组的建议，将喉镜检查次数限制在3次，以代替可能发生的相当大的患者损伤。
Repeated conventional tracheal intubation attempts may contribute to patient morbidity. Critically-ill patients (n = 2833) suffering from cardiovascular, pulmonary, metabolic, neurologic, or trauma-related deterioration were entered into an emergency intubation quality improvement database. This practice analysis was evaluated for airway and hemodynamic-related complications based on a set of defined variables that were correlated to the number of attempts required to successfully intubate the trachea outside the operating room. There was a significant increase in the rate of airway-related complications as the number of laryngoscopic attempts increased (< 2 versus >2 attempts): hypoxemia (11.8% versus 70%), regurgitation of gastric contents (1.9% versus 22%), aspiration of gastric contents (0.8% versusl 3%) bradycardia (1.60% versus 21%), and cardiac arrest (0.7% versus 110%; P < 0.001). Although predictable, this analysis provides data that confirm the number of laryngoscopic attempts is associated with the incidence of airway and hemodynamic adverse events. These data support the recommendation of the ASA Task Force on the Management of the Difficult Airway to limit laryngoscopic attempts to three in lieu of the considerable patient injury that may occur.