Zuckerbraun Noel S, Pitetti Raymond D, Herr Sandra M, Roth Kimberly R, Gaines Barbara A, King Christopher
Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Acad Emerg Med. 2006 Jun;13(6):602-9. doi: 10.1197/j.aem.2005.12.026. Epub 2006 Apr 24.
Although etomidate is widely used for rapid sequence intubation (RSI), there is no consensus on the optimal induction agent and no prospective pediatric emergency department (ED) study exists. The objective of this study was to assess the effectiveness and safety of etomidate as an induction agent for RSI in the pediatric ED.
Data on RSI conditions and complications were collected prospectively on patients undergoing RSI in a tertiary pediatric ED from January 2003 to December 2003. ED hemodynamic data and inpatient data were collected retrospectively via chart review.
Seventy-seven of 101 patients requiring intubation underwent RSI with etomidate. The mean (+/- SD) age was 8.2 (+/- 6.2) years. All 77 patients were successfully intubated. Intubation condition data were available for 69 of 77 patients (89.6%). Conditions were good in 68 of 69 (99%; 95% confidence interval = 92.2% to 99.9%). The mean (+/- SD) maximal percent decrease in systolic blood pressure was 10% (+/- 13.6%). A greater than 20% maximal percent decrease in systolic blood pressure occurred in 12 of 69 patients (17.4%; 95% confidence interval = 9.3% to 28.4%). There was no relationship between seizures after etomidate administration and prior seizure history (p = 0.25). Corticosteroids were given to 29 of 77 patients post-RSI for varying diagnoses. All eight patients given corticosteroids for shock were in shock at the time of intubation.
In the pediatric ED setting, etomidate as an induction agent provided successful RSI conditions and resulted in varied hemodynamic changes that were especially favorable in those patients presenting in decompensated shock. Hypotension and seizures were uncommon and occurred in patients with confounding diagnoses. Until the significance of a single dose of etomidate on adrenal dysfunction is further clarified, caution should be used in those patients at risk for adrenal insufficiency.
尽管依托咪酯广泛用于快速顺序诱导插管（RSI），但对于最佳诱导药物尚无共识，且尚无前瞻性儿科急诊科（ED）研究。本研究的目的是评估依托咪酯作为儿科急诊科RSI诱导药物的有效性和安全性。
前瞻性收集2003年1月至2003年12月在一家三级儿科急诊科接受RSI患者的RSI情况及并发症数据。通过病历回顾回顾性收集急诊科血流动力学数据和住院患者数据。
101例需要插管的患者中有77例接受了依托咪酯RSI。平均（±标准差）年龄为8.2（±6.2）岁。所有77例患者均成功插管。77例患者中有69例（89.6%）可获得插管情况数据。69例中有68例情况良好（99%；95%置信区间=92.2%至99.9%）。收缩压最大降幅的平均（±标准差）百分比为10%（±13.6%）。69例患者中有12例（17.4%；95%置信区间=9.3%至28.4%）收缩压最大降幅超过20%。依托咪酯给药后癫痫发作与既往癫痫病史之间无相关性（p = 0.25）。77例患者中有29例在RSI后因不同诊断接受了皮质类固醇治疗。所有8例因休克接受皮质类固醇治疗的患者在插管时均处于休克状态。
在儿科急诊科环境中，依托咪酯作为诱导药物可提供成功的RSI条件，并导致血流动力学变化多样，这在失代偿性休克患者中尤为有利。低血压和癫痫发作并不常见，且发生在有混杂诊断的患者中。在单剂量依托咪酯对肾上腺功能障碍的影响进一步明确之前，应对有肾上腺功能不全风险的患者谨慎使用。
