Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma 74135, USA.
Prehosp Emerg Care. 2010 Jul-Sep;14(3):283. doi: 10.3109/10903127.2010.481758.
To assess critical care transport (CCT) crews' endotracheal intubation (ETI) attempts, success rates, and peri-ETI oxygenation.
Participants were adult and pediatric patients undergoing attempted advanced airway management during the period from July 2007 to December 2008 by crews from 11 CCT programs varying in geography, crew configuration, and casemix; all crews had access to neuromuscular-blocking agents. Data collected included airway management variables defined per national consensus criteria. Descriptive analysis focused on ETI success rates (reported with exact binomial 95% confidence intervals [CIs]) and occurrence of new hypoxemia (oxygen saturation [SpO(2)] dropping below 90% during or after ETI); to assess categorical variables, Fisher's exact test, Pearson chi(2), and logistic regression were employed to explore associations between predictor variables and ETI failure or new hypoxemia. For all tests, p < 0.05 defined significance.
There were 603 total attempts at airway management, with successful oral or nasal ETI in 582 cases, or 96.5% (95% CI 94.7-97.8%). In 182 cases (30.2%, 95% CI 26.5-34.0%), there were failed ETI attempts prior to CCT crew arrival; CCT crew ETI success on these patients (96.2%, 95% CI 92.2-98.4%) was just as high as in the patients in whom there was no pre-CCT ETI attempt (p = 0.81). New hypoxemia occurred in only six cases (1.6% of the 365 cases with ongoing SpO(2) monitoring; 95% CI 0.6-3.5%); the only predictor of new hypoxemia was pre-ETI hypotension (p < 0.001). A requirement for multiple ETI attempts by CCT crews was not associated with new hypoxemia (Fisher's exact p = 0.13).
CCT crews' ETI success rates were very high, and even when ETI required multiple attempts, airway management was rarely associated with SpO(2) derangement. CCT crews' ETI success rates were equally high in the subset of patients in whom ground emergency medical services (EMS) ETI failed prior to arrival of transport crews.
评估重症监护转运（CCT）人员的气管内插管（ETI）尝试、成功率和围 ETI 期氧合情况。
参与者为 2007 年 7 月至 2008 年 12 月期间，来自 11 个 CCT 项目的成年和儿科患者，这些项目在地理位置、机组配置和病例组合方面各不相同；所有机组都可以使用神经肌肉阻滞剂。收集的数据包括按照国家共识标准定义的气道管理变量。描述性分析集中在 ETI 成功率（报告确切的二项式 95%置信区间[CI]）和新出现的低氧血症（ETI 过程中或之后 SpO2 下降到 90%以下）的发生率；为了评估分类变量，采用 Fisher 精确检验、Pearson chi(2)和逻辑回归来探讨预测变量与 ETI 失败或新出现的低氧血症之间的关系。所有检验中，p<0.05 定义为差异有统计学意义。
共有 603 次气道管理尝试，其中 582 例（96.5%，95%CI 94.7-97.8%）成功进行了经口或经鼻 ETI。在 182 例（30.2%，95%CI 26.5-34.0%）患者中，在 CCT 机组到达之前，ETI 尝试失败；在这些患者中，CCT 机组 ETI 的成功率（96.2%，95%CI 92.2-98.4%）与那些没有进行预 CCT ETI 尝试的患者一样高（p=0.81）。仅在 6 例（365 例中 SpO2 持续监测的 1.6%；95%CI 0.6-3.5%）患者中出现新的低氧血症；新出现低氧血症的唯一预测因素是 ETI 前低血压（p<0.001）。CCT 机组需要多次 ETI 尝试与新的低氧血症无关（Fisher 精确检验 p=0.13）。
CCT 机组的 ETI 成功率非常高，即使需要多次尝试 ETI，气道管理也很少与 SpO2 紊乱相关。在接受转运机组治疗的患者亚组中，当地面紧急医疗服务（EMS）的 ETI 在机组到达之前失败时，CCT 机组的 ETI 成功率同样很高。
