Reintubation in critically ill patients: procedural complications and implications for care.
Reintubation in critically ill patients: procedural complications and implications for care.
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DOI：
10.1186/s13054-014-0730-7
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发表时间：
2015-01-16
期刊：
影响因子：
--
通讯作者：
Emlet L
中科院分区：
文献类型：
--
作者：
Elmer J;Lee S;Rittenberger JC;Dargin J;Winger D;Emlet L
在重症患者中，重新插管是常见的，可能是一种高风险的手术。预测困难的气道并识别高风险患者可以为挽救生命的准备留出时间。不幸的是，前瞻性研究没有比较这一人群中与再插管相关的困难或并发症发生率。我们对一项前瞻性登记的院内紧急气道管理进行了二次分析，重点是在一次住院期间接受多次手术室外插管的患者。我们关注的主要结局是插管的技术难度（尝试次数、直接喉镜检查的需要、最佳Cormack-Lehane分级和最终插管者的培训水平）和手术并发症的频率（误吸、心律失常、气道创伤、新发低血压、新发缺氧、食管插管和心脏骤停）。我们比较了再次插管患者队列与匹配的单次插管患者队列，并比较了每个重复插管患者的首次和末次插管。我们的登记研究包括1053例患者，其中151例（14%）重复插管（每例患者平均2次）。与首次插管相比，末次插管期间并发症明显更常见（13% vs 5%，P = 0.02）。最常见的并发症是低血压（41%）和缺氧（35%）。尽管在插管的技术难度方面没有任何差异，但仍发生了这些情况。在该重新插管患者队列中，与首次插管相比，最后一次插管的临床重要手术并发症明显更常见。
In critically ill patients, re-intubation is common and may be a high-risk procedure. Anticipating a difficult airway and identifying high-risk patients can allow time for life-saving preparation. Unfortunately, prospective studies have not compared the difficulty or complication rates associated with reintubation in this population. We performed a secondary analysis of a prospective registry of in-hospital emergency airway management, focusing on patients that underwent multiple out-of-operating room intubations during a single hospitalization. Our main outcomes of interest were technical difficulty of intubation (number of attempts, need for adjuncts to direct laryngoscopy, best Cormack-Lehane grade and training level of final intubator) and the frequency of procedural complications (aspiration, arrhythmia, airway trauma, new hypotension, new hypoxia, esophageal intubation and cardiac arrest). We compared the cohort of reintubated patients to a matched cohort of singly intubated patients and compared each repeatedly intubated patient’s first and last intubation. Our registry included 1053 patients, of which 151 patients (14%) were repeatedly intubated (median two per patient). Complications were significantly more common during last intubation compared to first (13% versus 5%, P = 0.02). The most common complications were hypotension (41%) and hypoxia (35%). These occurred despite no difference in any measure of technical difficultly across intubations. In this cohort of reintubated patients, clinically important procedural complications were significantly more common on last intubation compared to first.
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影响因子：
1.8
作者：
Hoenig, JM;Heisey, DM
通讯作者：
Heisey, DM
影响因子：
2.6
作者：
House, Joyce Colton;Noordzij, J. Pieter;Langmore, Susan
通讯作者：
Langmore, Susan
影响因子：
--
作者：
Manley, G;Knudson, MM;Pitts, L
通讯作者：
Pitts, L
DOI：
10.1007/bf03011034
发表时间：
1995-10-01
期刊：
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
影响因子：
--
作者：
ELBEHEIRY, H;KIM, J;SEEGOBIN, R
通讯作者：
SEEGOBIN, R
影响因子：
5.7
作者：
Mort, TC
通讯作者：
Mort, TC