Dunford James V, Davis Daniel P, Ochs Mel, Doney Michael, Hoyt David B
Department of Emergency Medicine, University of California-San Diego, USA.
Ann Emerg Med. 2003 Dec;42(6):721-8. doi: 10.1016/s0196-0644(03)00660-7.
We determine the incidence of desaturation and pulse rate reactivity during paramedic rapid sequence intubation of patients with severe head injuries (Glasgow Coma Scale score <or=8).
Adult patients with severe head injuries had recording oximeter-capnometers applied before rapid sequence intubation. Desaturation was defined as a reduction in oxygen saturation (Spo(2)) to less than 90% from an initial Spo(2) of greater than or equal to 90% or a decrease from a baseline of less than 90%. Event records were analyzed with emergency medical services (EMS) run sheets and debriefing reports.
Thirty-one (57%) of 54 patients demonstrated desaturation during rapid sequence intubation. Twenty-six (84%) of these 31 events occurred in patients whose initial Spo(2) value with basic airway skills was greater than or equal to 90%. The median duration of desaturation was 160 seconds (interquartile range 48 to 272 seconds), and the median decrease in Spo(2) was 22%. Six (19%) patients experienced marked bradycardia (pulse rate <50 beats/min) during desaturation events. Paramedics described rapid sequence intubation as "easy" in 26 (84%) of 31 patients with desaturation.
Out-of-hospital rapid sequence intubation by paramedics was complicated by a concerning incidence of desaturation and bradycardia. Paramedic reports did not reflect the presence of these concerning derangements. Most patients had acceptable Spo(2) values before rapid sequence intubation. An effective strategy for preoxygenation is needed before it can be concluded that rapid sequence intubation is of value in the out-of-hospital care of patients with serious closed head injury.
我们确定在对重度颅脑损伤患者（格拉斯哥昏迷量表评分≤8分）进行护理人员快速顺序插管期间血氧饱和度降低和脉搏率反应性的发生率。
对重度颅脑损伤的成年患者在快速顺序插管前应用血氧饱和度仪 - 二氧化碳监测仪进行记录。血氧饱和度降低定义为氧饱和度（Spo₂）从初始Spo₂≥90%降至低于90%，或从基线低于90%开始下降。事件记录通过紧急医疗服务（EMS）运行表和汇报报告进行分析。
54例患者中有31例（57%）在快速顺序插管期间出现血氧饱和度降低。这31例事件中有26例（84%）发生在初始Spo₂值在基本气道技能操作时≥90%的患者中。血氧饱和度降低的中位持续时间为160秒（四分位间距48至272秒），Spo₂的中位下降幅度为22%。6例（19%）患者在血氧饱和度降低事件期间出现明显心动过缓（脉搏率<50次/分钟）。护理人员称31例出现血氧饱和度降低的患者中有26例（84%）的快速顺序插管“容易”。
护理人员在院外进行快速顺序插管时，血氧饱和度降低和心动过缓的发生率令人担忧，使操作变得复杂。护理人员的报告未反映出这些令人担忧的紊乱情况。大多数患者在快速顺序插管前的Spo₂值是可接受的。在得出快速顺序插管对严重闭合性颅脑损伤患者的院外护理有价值的结论之前，需要一种有效的预充氧策略。
