神经肌肉阻滞剂与紧急气管插管结果之间的关系：随机试验的二次分析。

IF 5 1区医学 Q1 EMERGENCY MEDICINE

Annals of emergency medicine Pub Date : 2025-01-01 DOI:10.1016/j.annemergmed.2024.08.509

Stephanie C. DeMasi MD , Wesley H. Self MD, MPH , Neil R. Aggarawal MD, MHSc , Michael D. April MD , Luke Andrea MD , Christopher R. Barnes MD , Jason Brainard MD , Veronika Blinder DO , Alon Dagan MD , Brian Driver MD , Kevin C. Doerschug MD , Ivor Douglas MD , Matthew Exline MD, MPH , Daniel G. Fein MD , John P. Gaillard MD , Sheetal Gandotra MD , Kevin W. Gibbs MD , Adit A. Ginde MD, MPH , Stephen J. Halliday MD, MSCI , Jin H. Han MD , Matthew W. Semler MD, MSc

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引用次数: 0

摘要

研究目的：研究在急诊科（ED）或重症监护室对重症成人进行气管插管时，所使用的神经肌肉阻断剂（琥珀胆碱与罗库溴铵）与首次插管成功率和严重并发症发生率之间的关系。方法：我们对在急诊科或重症监护室对重症成人进行气管插管的两项多中心随机试验的数据进行了二次分析。我们使用带有预设基线协变量的广义线性混合效应模型，研究了所使用的神经肌肉阻断剂（琥珀胆碱与罗库溴铵）与首次尝试成功插管的发生率（主要结果）和气管插管期间严重并发症的发生率（次要结果）之间的关系。结果在试验数据集中的 2,440 名患者中，2,339 名（95.9%）纳入了本次分析；475 名患者（20.3%）接受了琥珀胆碱治疗，1,864 名患者（79.7%）接受了罗库溴铵治疗。375名接受琥珀胆碱治疗的患者（78.9%）和1,510名接受罗库溴铵治疗的患者（81.0%）首次尝试就成功插管（调整后的几率比为0.87；95% CI为0.65至1.15）。结论在接受气管插管的重症成人患者中，接受琥珀胆碱的患者和接受罗库洛宁的患者在首次插管成功率和严重并发症的发生率上没有显著差异。

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Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials

Study objective

To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU.

Methods

We performed a secondary analysis of data from 2 multicenter randomized trials in critically ill adults undergoing tracheal intubation in an ED or ICU. Using a generalized linear mixed-effects model with prespecified baseline covariates, we examined the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt (primary outcome) and severe complications during tracheal intubation (secondary outcome).

Results

Among the 2,440 patients in the trial data sets, 2,339 (95.9%) were included in the current analysis; 475 patients (20.3%) received succinylcholine and 1,864 patients (79.7%) received rocuronium. Successful intubation on the first attempt occurred in 375 patients (78.9%) who received succinylcholine and 1,510 patients (81.0%) who received rocuronium (an adjusted odds ratio of 0.87; 95% CI 0.65 to 1.15). Severe complications occurred in 67 patients (14.1%) who received succinylcholine and 456 patients (24.5%) who received rocuronium (adjusted odds ratio, 0.88; 95% CI 0.62 to 1.26).

Conclusion

Among critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.

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来源期刊

Annals of emergency medicine 医学-急救医学

CiteScore

8.30

自引率

4.80%

发文量

819

审稿时长

20 days

期刊介绍： Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics.