急诊

危重病人气管插管倾斜位比较嗅物位的多中心随机试验。

作者:姜辉,曹广慧 来源:急诊界 日期:2017-07-14
导读

         低氧血症是危重症成人患者气管内插管最常见的并发症。倾斜位插管被认为可以通过增加功能残气量和降低插管时限来预防低氧血症,但这种假设从未在手术室外研究过。

        AMulticenter,RandomizedTrialofRampedPositionversusSniffingPositionduringEndotrachealIntubationofCriticallyIllAdults.

        危重病人气管插管倾斜位比较嗅物位的多中心随机试验。

        BACKGROUND 背景

        Hypoxemia is the most common complication duringendotrachealintubationofcriticallyilladults.Intubationin therampedpositionhas been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration ofintubation, but has never been studied outside of the operating room.

        低氧血症是危重症成人患者气管内插管最常见的并发症。倾斜位插管被认为可以通过增加功能残气量和降低插管时限来预防低氧血症,但这种假设从未在手术室外研究过。

        METHODS 方法

        Multicenter,randomizedtrialcomparingrampedposition(head of the bed elevated to 25 degrees) tosniffingposition(torso supine, neck flexed, head extended) among 260adultsundergoingendotrachealintubationby Pulmonary and Critical Care Medicine fellows in four intensive care units between July 22, 2015 and July 19, 2016. The primary outcome was lowest arterial oxygen saturation between induction and two minutes afterintubation. Secondary outcomes included Cormack-Lehane grade of glottic view, difficulty ofintubation, and number of laryngoscopy attempts.

        多中心、随机试验,在 2015 年 7 月 22 日至 2016 年 7 月 19 日的四个重症监护病房中,肺部和危重病医学的研究员对260 位成年患者进行气管插管操作,并比较倾斜位(床头升高25度)和嗅物位(躯干仰卧位,颈部弯曲,头伸展)的成果。主要结果是插管和插管后的2分钟之间的最低动脉血氧饱和度。次要结局包括喉镜暴露视野的Cormack-Lehane分级、困难气管插管和喉镜尝试插管的次数。

        RESULTS 结果

        The median lowest arterial oxygen saturation was 93% [IQR 84-99%] withrampedpositionversus92% [IQR 79-98%] withsniffingposition(P = .27).Rampedpositionappeared to increase the incidence of grade III or IV view (25.4% vs 11.5%, P = .01), increase the incidence of difficultintubation(12.3% vs 4.6%, P = .04), and decrease the rate ofintubationon the first attempt (76.2% vs 85.4%, P = .02).

        平均最低动脉血氧饱和度倾斜位为93%[IQR 84-99%] 、嗅物位为92%[IQR 79-98%] 。倾斜位能增加III级或IV分级喉镜暴露视野(25.4% 对比 11.5%, P = .01),增加困难插管发生率(12.3% 对比 4.6%, P = .04),降低第一次尝试插管的成功率(76.2% 对比 85.4%, P = .02)。

        CONCLUSIONS 结论

        In thismulticentertrial,rampedpositiondid not improve oxygenation duringendotrachealintubationofcriticallyilladultscompared tosniffingposition.Rampedpositionmay worsen glottic view and increase the number of laryngoscopy attempts required for successfulintubation.

        在这个多中心试验中,对比嗅物位,倾斜位并未改善重症患者插管期间的氧合。倾斜位可能使喉镜暴露视野更差,而且增加插管成功的喉镜尝试次数。

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