临床决策和过程的并发症在预期的艰难的气道管理的选择性外科手术
Isabelle T Yang1,2, Avery Tung3, Kelsey S Flores4
1From the Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Anesthesia and analgesia
|December 17, 2024
概括
在接受非紧急手术的成年人中,呼吸道管理困难 (DAM) 在所有情况下都是成功的. 醒着的输液管,只用于复杂的病例,呈现出比麻醉输液管更高的并发症率.
科学领域:
- 麻醉学 麻醉学
- 临界护理医学 临界护理医学
- 航空航道管理的管理.
背景情况:
- 呼吸道管理困难 (DAM) 在麻醉护理中带来了重大挑战.
- 虽然大多数DAM插曲的结果是成功输管,但并发症很常见,需要复杂的临床决策.
- 这项研究侧重于预期的DAM在预定进行非紧急手术的成年人.
研究的目的:
- 为了在预期的困难的气道管理期间前性地观察临床决策.
- 分析与不同气道管理方法相关的过程并发症的发生率.
- 描述结果,包括输管成功,试验数量和患者稳定性.
主要方法:
- 从2009年至2014年,对1245名成年人的1295次预期的DAM发作进行了前性观察.
- 训练有素的观察员记录了气道管理决策和过程并发症.
- 记录的结果包括输管试验,需要袋口罩通风 (BMV),低氧化和心血管不稳定.
主要成果:
- 所有的输内管术都是成功的;没有一个病例因呼吸道故障而被取消.
- 13%的患者在清醒状态下被输管,往往有更困难的呼吸道指标和更高的低氧化率 (50%) 和心血管不稳定 (29%).
- 在麻醉期间输入管道的患者 (87%) 的第一通成功率更高 (64%),但仍有显著的并发症,如低氧症 (30%).
结论:
- 气道管理在普遍情况下是成功的,尽管过程并发症比常规情况下更常见.
- 醒着输管,虽然保留给更具挑战性的呼吸道,但显示出更高的并发症率,表明其固有的困难.
- 经历了失败的麻醉输管尝试和困难的口罩呼吸的患者面临后续并发症的高风险,特别是低氧化症.
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