Can Nebulized Naloxone Be Used Safely and Effectively by Emergency Medical Services for Suspected Opioid Overdose?
Can Nebulized Naloxone Be Used Safely and Effectively by Emergency Medical Services for Suspected Opioid Overdose?
复制标题
紧急医疗服务可以安全有效地使用雾化纳洛酮治疗疑似阿片类药物过量吗？
DOI：
10.3109/10903127.2011.640763
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发表时间：
2012
影响因子：
2.4
通讯作者：
M. Mycyk
中科院分区：
文献类型：
--
作者：
Joseph M. Weber;Katie L. Tataris;Joyce D Hoffman;S. Aks;M. Mycyk
抽象背景。紧急医疗服务（EMS）传统上使用针头给药纳洛酮。无针纳洛酮可能更容易当静脉注射（IV）访问是困难的，并可能减少职业性血源性暴露在这个高风险人群。几项研究已经检查了鼻内纳洛酮，但雾化纳洛酮作为一种替代无针途径尚未在院前环境中进行检查。objective.我们试图确定雾化纳洛酮是否可以安全有效地用于疑似阿片类药物过量患者的院前提供者。方法.我们对2010年1月1日至6月30日期间由芝加哥消防局给予雾化纳洛酮的所有连续病例进行了回顾性分析。将所有临床数据真实的实时输入结构化EMS数据库，并以系统的方式进行数据提取。纳入了疑似阿片类药物过量、精神状态改变和呼吸抑制的病例;排除了接受雾化纳洛酮治疗阿片类药物触发的哮喘的病例和结局数据不完整的病例。主要结局是患者对雾化纳洛酮的反应。次要结局包括需要急救纳洛酮（IV或肌肉注射）、需要辅助通气和不良解毒剂事件。计算Kappa评分者间信度，并使用描述性统计分析研究数据。结果在129例病例中，105例符合入选标准。其中，23例（22%）完全缓解，62例（59%）部分缓解，20例（19%）无缓解。11例（10%）接受了急救纳洛酮，无一例需要辅助通气，无不良事件发生。Kappa评分为0.993。结论雾化纳洛酮是一种安全有效的无针替代方法，可用于自发呼吸患者中疑似阿片类药物过量的院前治疗。
Abstract Background. Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting. Objective. We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose. Methods. We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics. Results. Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete response, 62 (59%) had partial response, and 20 (19%) had no response. Eleven cases (10%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993. Conclusion. Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations.