在紧急输管过程中用于氧化前的非侵入性通风
Kevin W Gibbs1, Matthew W Semler1, Brian E Driver1
1From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine (M.W.S., K.P.S., A. Muhs, T.W.R., J.R., K.W., J.D.C.), the Departments of Emergency Medicine (W.H.S., B.D.L.) and Biostatistics (B.I.), and Vanderbilt Institute for Clinical and Translational Research (W.H.S., B.D.L.), Vanderbilt University Medical Center, Nashville; the Department of Emergency Medicine (B.E.D., M.E.P., S.J. Hansen) and the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J. Hansen), Hennepin County Medical Center, Minneapolis; the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington (S.B.S., J.M.W.), and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.) - both in Massachusetts; the Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (C.T., P.J.K.); the Department of Emergency Medicine (D.R.-A., S.G.S., C.W., S.A.T., V.S.B., A.A.G.) and the Center for COMBAT Research (V.S.B.), University of Colorado School of Medicine, and the Department of Medicine, Division of Pulmonary Sciences and Critical Care (N.R.A., P.D.S.), and the Department of Anesthesiology (J.C.B., S.G.S., N.K.), University of Colorado Anschutz Medical Campus - both in Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baylor Scott and White Medical Center, Temple (H.D.W., S.A.G.), and U.S. Army Institute of Surgical Research (S.G.S., B.J.L.) and Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston (S.G.S., B.J.L.), and the 59th Medical Wing, Joint Base San Antonio-Lackland (B.J.L.), San Antonio - all in Texas; the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (S.G., M.R.W., D.W.R., D.B.P.), and the Departments of Emergency Medicine (M.R.W.) and Anesthesiology and Perioperative Medicine (A.B.B.), Heersink School of Medicine, University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Pulmonary Section (D.W.R.) - both in Birmingham; the Department of Internal Medicine, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City (K.C.D., A.S.); the Department of Critical Care Medicine (A. Mohamed, L.A., V.B., A. Moskowitz, R.M.) and the Department of Medicine, Pulmonary Division (D.G.F.), Montefiore Einstein, Bronx, NY; the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland (A.K., G.A.); Our Lady of the Lake Regional Medical Center, Emergency Medicine Residency Program-Baton Rouge Campus (L.H.B., S.M.A.), and the Department of Pulmonary and Critical Care Medicine, Internal Medicine Residency Program-Baton Rouge Campus (J.E.W., C.B.T.), Louisiana State University Health Sciences Center School of Medicine-New Orleans, Baton Rouge; the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine (S.J. Halliday, M.T.L.), and the Department of Anesthesia (M.T.L.), University of Wisconsin-Madison School of Medicine and Public Health, Madison; the Department of Emergency Medicine, Denver Health Medical Center, Denver (S.A.T.); and the University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine, New Orleans (D.R.J.).
与氧气口罩相比,在重症患者的成年人中,在气管输管过程中,预氧化与非侵入性通风显著降低了氧气低血. 这种关键护理干预措施提高了呼吸道管理期间的患者安全.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 紧急医疗 紧急医疗
背景情况:
- 在气管管道输液过程中出现的低氧症对严重病情严重的成年人构成重大风险,包括心脏骤停和死亡.
- 氧化前方法的比较有效性,特别是非侵入性通风与氧气口罩的比较,在输管过程中预防缺氧仍然不清楚.
研究的目的:
- 评估严重病情的成年人气管输入过程中缺氧的发生率.
- 为了比较使用非侵入性通风对抗氧化前的氧化前效果,使用氧气面罩进行氧化前效果.
主要方法:
- 一个多中心的随机试验,涉及1301名患病危急的成年人接受气管输管.
- 参与者被分配通过非侵入性通风或氧气面具接受氧化前治疗.
- 主要结局被定义为从麻醉诱导到输管后2分钟的氧气和率低于85%.
主要成果:
- 低氧症发生在非侵入性通风组的9.1%的患者中,而氧气口罩组的18.5% (P<0.001).
- 非侵入式通风组的低氧化症发病率显著降低 (-9.4个百分点).
- 非侵入式通风组的心脏骤停率较低 (0.2%对1.1%).
结论:
- 带有非侵入性通风的预氧化比氧气口罩更有效,可以在严重病情的成年人中在气管输管过程中预防低氧化.
- 这一发现表明非侵入性通风是这种患者群体中预氧化的首选策略.
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