Evaluation of Reduced-Dose Induction Agents During Endotracheal Intubation in Critical Care Transport

Q3 Nursing

Air Medical Journal Pub Date : 2025-01-01 DOI:10.1016/j.amj.2024.11.009

Kalle J. Fjeld MD , Alissa M. Bates MD , Matthew A. Roginski MD, MPH , Ryan J. Ding , Alyson M. Esteves PharmD, BCPS, BCCCP

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引用次数: 0

Abstract

Objective

Induction agent selection and dose are potentially modifiable risk factors to mitigate postintubation hypotension and hemodynamic collapse. Despite it being a common practice, minimal literature exists to support induction agent dose reduction. Our objective was to evaluate the rate of postintubation hemodynamic collapse with reduced-dose compared to full dose induction agents.

Methods

This is a retrospective chart review of adult patients who were endotracheally intubated by a critical care transport team and received etomidate or ketamine for induction. The primary outcome was association of reduced-dose induction agent use (etomidate <0.2 mg/kg or ketamine <1 mg/kg) with postintubation hemodynamic collapse.

Results

A total of 304 patients were included; 187 (61.5%) received etomidate and 117 (38.5%) received ketamine. Of these 304 patients, 64 (21.1%) received reduced-dose agents and 240 (78.9%) received full-dose agents. The initial systolic blood pressure and mean arterial blood pressure levels were lower in the reduced-dose arm. Shock index, hemodynamic collapse, and life-threatening hemodynamic collapse did not differ between the groups.

Conclusion

In this analysis, there was no difference in rates of postintubation hemodynamic collapse with reduced-dose induction agents when compared with full-dose agents.

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低剂量诱导剂在危重病人气管插管中的应用评价

目的探讨诱导剂的选择和剂量是减轻插管后低血压和血流动力学衰竭的潜在危险因素。尽管这是一种常见的做法，但支持减少诱导剂剂量的文献很少。我们的目的是评估与全剂量诱导剂相比，减少剂量诱导剂插管后血流动力学衰竭的发生率。方法回顾性分析重症监护转运组气管内插管并使用依托咪酯或氯胺酮诱导的成年患者。主要结局是使用低剂量诱导剂（依托咪酯0.2 mg/kg或氯胺酮1mg /kg）与插管后血流动力学衰竭的关系。结果共纳入304例患者；应用依托咪酯187例（61.5%），氯胺酮117例（38.5%）。在这304例患者中，64例（21.1%）接受了减少剂量药物治疗，240例（78.9%）接受了全剂量药物治疗。减少剂量组的初始收缩压和平均动脉血压水平较低。休克指数、血流动力学衰竭和危及生命的血流动力学衰竭在两组之间没有差异。结论在本分析中，与全剂量诱导药物相比，减少剂量诱导药物对插管后血流动力学衰竭的发生率没有差异。

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

Air Medical Journal Nursing-Emergency Nursing

CiteScore

1.20

自引率

0.00%

发文量

112

审稿时长

69 days

期刊介绍： Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.