Davis Daniel P, Heister Robyn, Poste Jennifer C, Hoyt David B, Ochs Mel, Dunford James V
Department of Emergency Medicine, University of California-San Diego, San Diego, CA, USA.
Neurocrit Care. 2005;2(2):165-71. doi: 10.1385/NCC:2:2:165.
Inadvertent hyperventilation has been documented during aeromedical transports but has not been studied following paramedic rapid sequence intubation (RSI). The San Diego Paramedic RSI Trial was designed to study the impact of paramedic RSI on outcome in patients with severe head injury. This analysis explores ventilation patterns in a cohort of trial patients undergoing end-tidal CO2 (ETCO2) monitoring.
Adult patients with severe head injury (Glasgow Coma Score: 3-8) unable to be intubated without RSI were prospectively enrolled in the trial. Midazolam and succinylcholine were used for RSI; rocuronium was administered following tube confirmation. Standardized ventilation protocols were used by most paramedics; however, one agency instituted ETCO2 monitoring during the second trial year, with paramedics instructed to target ETCO2 values of 30 to 35 mmHg. The incidence and duration of inadvertent hyperventilation (ETCO2: <30 mmHg) and severe hyperventilation (ETCO2: <25 mmHg) were explored for patients undergoing ETCO2 monitoring. The initial, final, minimum, and maximum values for ETCO2 and the maximum and minimum ventilatory rate values were also calculated using descriptive statistics (95% confidence interval). The pattern of ETCO2 values over time and distribution of recorded ventilatory rate values were explored graphically.
A total of 76 trial patients had adequate ETCO2 data for this analysis. The mean values for initial, final, maximum, and minimum ETCO2 were 40.8 (range: 37.5-44.2), 28.4 (range: 25.4-31.4), 45.1 (range: 41.4-48.8), and 23.5 mmHg (range: 21.4-25.5), respectively. The mean maximum and minimum ventilatory rate values were 36.0/minute (range: 33.5-38.5) and 12.8/minute (range: 11.9-13.7), respectively. ETCO2 values less than 30 and 25 mmHg were documented in 79% and 59% of patients, respectively, with mean durations of 485 (range: 378-592) and 390 seconds (range: 285-494).
Inadvertent hyperventilation is common following paramedic RSI, despite ETCO2 monitoring and target parameters.
在航空医疗转运过程中曾有过无意过度通气的记录，但在护理人员快速顺序诱导插管（RSI）后尚未进行过研究。圣地亚哥护理人员RSI试验旨在研究护理人员RSI对重型颅脑损伤患者预后的影响。本分析探讨了一组接受呼气末二氧化碳（ETCO2）监测的试验患者的通气模式。
前瞻性纳入了因重型颅脑损伤（格拉斯哥昏迷评分：3 - 8分）而在无RSI情况下无法插管的成年患者。咪达唑仑和琥珀酰胆碱用于RSI；插管确认后给予罗库溴铵。大多数护理人员采用标准化通气方案；然而，在试验的第二年，有一个机构开始进行ETCO2监测，并指示护理人员将ETCO2值目标设定为30至35 mmHg。对接受ETCO2监测的患者，探讨无意过度通气（ETCO2：<30 mmHg）和严重过度通气（ETCO2：<25 mmHg）的发生率和持续时间。还使用描述性统计（95%置信区间）计算了ETCO2的初始、最终、最低和最高值以及最大和最小通气率值。以图形方式探讨了ETCO2值随时间的变化模式以及记录的通气率值的分布情况。
共有76例试验患者有足够的ETCO2数据用于本分析。ETCO2的初始、最终、最高和最低平均值分别为40.8（范围：37.5 - 44.2）、28.4（范围：25.4 - 31.4）、45.1（范围：41.4 - 48.8）和23.5 mmHg（范围：21.4 - 25.5）。通气率的平均最高和最低值分别为36.0/分钟（范围：33.5 - 38.5）和12.8/分钟（范围：11.9 - 13.7）。分别有79%和59%的患者记录到ETCO2值低于30和25 mmHg，平均持续时间分别为485（范围：378 - 592）和390秒（范围：285 - 494）。
尽管进行了ETCO2监测并设定了目标参数，但护理人员RSI后无意过度通气仍很常见。
