Department of Emergency Medicine, UC San Diego, San Diego, CA 92103-8676, USA.
Crit Care. 2011 Mar 14;15(2):133. doi: 10.1186/cc10039.
Despite a widespread belief in the value of aggressive prehospital airway management, the therapeutic benefits of early tracheal intubation (TI) remain unclear. In fact, most attempts to elucidate the benefits of prehospital TI on outcome from traumatic brain injury and cardiopulmonary arrest have documented an increase in mortality associated with the procedure. While some degree of selection bias is likely present in these studies, the inherent adverse physiological effects of intubation and a high incidence of desaturation and subsequent hyperventilation may indicate a harmful effect of the procedure. This uncertainty regarding such a fundamental resuscitation procedure as TI underscores the need for standardized data reporting in prehospital airway management research. To this end, the Utstein prehospital airway conference proposed a set of variables that would move us in that direction. However, the present article by Lossius and colleagues documents how far we still have to travel before such standardization can be achieved. Only through these efforts can we elucidate the true benefits - or harm - of advanced airway management during critical resuscitation.
尽管人们普遍认为积极的院前气道管理具有价值,但早期气管插管(TI)的治疗益处仍不清楚。事实上,大多数试图阐明院前 TI 对创伤性脑损伤和心肺骤停结局益处的研究都记录到与该操作相关的死亡率增加。虽然这些研究中可能存在一定程度的选择偏倚,但插管的固有不利生理效应以及饱和度降低和随后过度通气的高发率可能表明该操作具有有害影响。这种对 TI 等基本复苏操作的不确定性强调了在院前气道管理研究中需要标准化数据报告。为此,Utstein 院前气道会议提出了一组变量,这些变量将推动我们朝这个方向发展。然而,Lossius 及其同事的这篇文章记录了在实现这种标准化之前我们还有多远的路要走。只有通过这些努力,我们才能阐明在关键复苏期间进行高级气道管理的真正益处——或危害。