在空中医疗快速插管过程中选择性使用正压通气进行预氧。

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Alexandra Herndon, Kira Chandran, Daniel P Davis
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引用次数: 0

摘要

背景:预吸氧对于安全实施快速顺序插管 (RSI) 至关重要。有人主张在预吸氧期间使用正压通气(PPV),但这可能会增加吸入风险:探讨在空中医疗 RSI 过程中使用 PPV 的风险效益分析:我们对 Air Methods 气道注册表进行了回顾性分析,使用了全美 175 个基地 5 年来的患者数据。患者被分为常氧血症(SpO2 ≥93%)和低氧血症(SpO2 ≥93%):研究期间共有 9778 名患者进行了插管。FAS 为 92%(8966 名患者)。FASWD为90%(8775名患者)。平均 SpO2 为 94.9%。42%的患者(4118 人)在插管前接受了 PPV,1% 的患者(94 人)在 RSI 期间吸入了气体。多变量统计回归显示,使用 PPV 与正常血氧患者插管成功率降低有关,但低氧血症患者的插管成功率有所提高。使用 PPV 与较高的吸入事件风险相关(p = 0.007):结论:RSI 前预吸氧期间使用 PPV 似乎对低氧血症患者有益,但对正常血氧患者无益,因为 PPV 会降低插管成功率并增加吸入风险。这些数据支持在接受 RSI 的患者首次尝试插管前选择性使用 PPV。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Selective Use of Positive-Pressure Ventilation for Preoxygenation During Air Medical Rapid Sequence Intubation.

Background: Preoxygenation is critical to safe performance of rapid sequence intubation (RSI). The use of positive-pressure ventilation (PPV) has been advocated during preoxygenation but may increase the risk of aspiration.

Objective: To explore the risk-benefit analysis of using PPV during air medical RSI.

Methods: We performed a retrospective analysis of the Air Methods Airway Registry using patient data from over 175 bases across the U.S. over a 5-year period. Patients were separated into normoxemic (SpO2 ≥93%) and hypoxemic (SpO2 <93%) and compared in regard to demographics, clinical data, and use of PPV. Primary outcomes were first-attempt intubation success (FAS) and FAS without desaturation (FASWD). Chi-square, t-test, and logistical regression were used to analyze the data.

Results: There were 9778 patients who underwent intubations during the study period. FAS was 92% (8966 patients). FASWD was 90% (8775 patients). Mean SpO2 was 94.9%. There were 42% (4118 patients) of patients who received PPV prior to intubation and 1% (94) aspirated during RSI. Multivariate logistical regression showed an association between use of PPV and reduced intubation success for normoxemic patients but improved intubation success for hypoxemic patients. The use of PPV was associated with higher risk of aspiration events (p = 0.007).

Conclusion: The use of PPV during preoxygenation prior to RSI appears beneficial for hypoxemic but not normoxemic patients due to lower intubation success and increased aspiration risk with PPV. This data supports selective use of PPV prior to the initial intubation attempt in patients undergoing RSI.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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