Effect of administration sequence of induction agents on first-attempt failure during emergency intubation: A Bayesian analysis of a prospective cohort.

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE
Pierre Catoire, Brian Driver, Matthew E Prekker, Yonathan Freund
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引用次数: 0

Abstract

Background: Emergency tracheal intubation is associated with a risk of clinical adverse events, including the risk of first-attempt failure. Induction agents usually include a sedative and a neuromuscular blocking agent (i.e., paralytic). Whether the order of administration (i.e., sedative vs. paralytic given first) is associated with first-attempt failure or adverse events is unknown.

Methods: This study analyzed data from a single-center prospective cohort collected from 2021 to 2024 at Hennepin County Medical Center, which included all patients undergoing orotracheal intubation in the emergency department. Patients with no detail on administration sequence order were excluded. A Bayesian logistic regression analysis was used to measure the effect of drug sequence order (sedative first vs. paralytic first). The primary outcome was first-attempt failure. The key secondary outcome was peri-intubation hypoxemia (SpO2 < 90%). We estimated the odds ratio (OR), 95% credible interval (CrI), and the probability that the OR was inferior to 1 (existence of an effect) and inferior to 0.9 (significant effect). Frequentist analysis and reanalysis with various priors were performed as sensitivity analyses.

Results: A total of 2216 patients were included for analysis. The most frequently used sedative and paralytic agents were etomidate (88.9%) and rocuronium (77.8%), respectively. The paralytic was given first to 56.6% of the patients. After adjustment for age, sex, body mass index, and sedative and paralytic agents, the OR for a paralytic-first strategy for first-attempt failure was 0.73 (95% CrI 0.46-1.02). The probability that the OR was less than 1 was estimated at 95.7% and less than 0.9 at 87.6%. There was a 33.5% and 8.0% probability that administering the paralytic first resulted in an OR < 1 and OR < 0.9 for the risk of hypoxemia, respectively. Sensitivity analyses were consistent with the main results.

Conclusions: In this Bayesian analysis a paralytic-first drug sequence was associated with reduced first-attempt failure during emergency tracheal intubation.

诱导剂给药顺序对紧急插管过程中首次尝试失败的影响:对前瞻性队列的贝叶斯分析。
背景:紧急气管插管有发生临床不良事件的风险,包括首次尝试失败的风险。诱导剂通常包括镇静剂和神经肌肉阻断剂(即麻痹剂)。给药顺序(即先给镇静剂还是先给麻痹剂)是否与首次尝试失败或不良事件有关尚不清楚:本研究分析了 2021 年至 2024 年期间在亨内平县医疗中心收集的单中心前瞻性队列数据,其中包括在急诊科接受气管插管的所有患者。没有详细说明给药顺序的患者被排除在外。贝叶斯逻辑回归分析用于衡量给药顺序(先镇静剂还是先麻痹剂)的影响。主要结果是首次尝试失败。主要次要结果是插管周围低氧血症(SpO2 结果):共纳入 2216 名患者进行分析。最常用的镇静剂和麻痹剂分别是依托咪酯(88.9%)和罗库洛铵(77.8%)。56.6%的患者首先使用了镇静剂。在对年龄、性别、体重指数、镇静剂和镇痛剂进行调整后,首次尝试失败的先用镇痛剂策略的OR值为0.73(95% CrI 0.46-1.02)。据估计,OR 小于 1 的概率为 95.7%,小于 0.9 的概率为 87.6%。首先使用麻痹剂导致 OR 结论的概率分别为 33.5%和 8.0%:在这项贝叶斯分析中,先用镇静剂的用药顺序与减少紧急气管插管过程中的首次尝试失败有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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