Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department
Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department
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DOI：
10.1038/s41598-019-53360-6
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发表时间：
2019-11-21
影响因子：
4.6
通讯作者：
Inoue, Akihiko
中科院分区：
文献类型：
--
作者：
Ishimaru, Tadayoshi;Goto, Tadahiro;Inoue, Akihiko
为了确定与其他镇静剂相比，氯胺酮用于气管插管是否与急诊科（艾德）血流动力学不稳定患者插管后低血压的风险降低相关，我们分析了一项前瞻性、多中心、观察性研究-第二次日本紧急气道网络（JEAN-2）研究-从2012年2月至2017年11月的数据。目前的分析包括插管前休克指数>= 0.9的成人非心脏骤停艾德患者。主要暴露是氯胺酮用作插管镇静剂，咪达唑仑或丙泊酚用作参考。主要结局为插管后低血压。本次分析共纳入977例患者。总体而言，24%的患者发生插管后低血压。氯胺酮组插管后低血压的风险低于对照组（15% vs 29%，未校正比值比[OR] 0.45 [95% CI 0.31-0.66] p < 0.001）。这种关联在多变量分析中仍然显著（校正OR 0.43 [95%CI 0.28-0.64] p < 0.001）。同样，在倾向评分匹配分析中，使用氯胺酮的患者插管后低血压的风险也显著降低（OR 0.47 [95%CI，0.31-0.71] P < 0.001）。我们的观察结果支持氯胺酮用作ED中血流动力学不稳定患者插管的安全镇静剂。
To determine whether ketamine use for tracheal intubation, compared to other sedative use, is associated with a lower risk of post-intubation hypotension in hemodynamically-unstable patients in the emergency department (ED), we analyzed the data of a prospective, multicenter, observational study-the second Japanese Emergency Airway Network (JEAN-2) Study-from February 2012 through November 2017. The current analysis included adult non-cardiac-arrest ED patients with a pre-intubation shock index of >= 0.9. The primary exposure was ketamine use as a sedative for intubation, with midazolam or propofol use as the reference. The primary outcome was post-intubation hypotension. A total of 977 patients was included in the current analysis. Overall, 24% of patients developed post-intubation hypotension. The ketamine group had a lower risk of post-intubation hypotension compared to the reference group (15% vs 29%, unadjusted odds ratio [OR] 0.45 [95% CI 0.31-0.66] p < 0.001). This association remained significant in the multivariable analysis (adjusted OR 0.43 [95% CI 0.28-0.64] p < 0.001). Likewise, in the propensity-score matching analysis, the patients with ketamine use also had a significantly lower risk of post-intubation hypotension (OR 0.47 [95% CI, 0.31-0.71] P < 0.001). Our observations support ketamine use as a safe sedative agent for intubation in hemodynamically-unstable patients in the ED.