急诊成人和小儿气管插管患者到达时的呼气末二氧化碳水平异常。

Abnormal end-tidal carbon dioxide levels on emergency department arrival in adult and pediatric intubated patients.

机构信息

Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California 95817, USA.

出版信息

Prehosp Emerg Care. 2012 Apr-Jun;16(2):210-6. doi: 10.3109/10903127.2011.640416. Epub 2012 Jan 4.

DOI:10.3109/10903127.2011.640416

PMID:22217189

Abstract

BACKGROUND

The utility of prehospital intubation is controversial, as uncontrolled studies in trauma patients suggest adverse outcomes with prehospital intubation, perhaps secondary to inappropriate ventilation once intubation is accomplished.

OBJECTIVES

The objectives were 1) to establish, immediately upon arrival to the emergency department (ED), the prevalence of abnormal end-tidal carbon dioxide (ETCO(2)) levels in patients with prehospital intubation and 2) to describe the relationship between abnormal ETCO(2) levels on ED arrival and mortality.

METHODS

This was a prospective, observational cohort study of patients with prehospital intubation. Patients were excluded if they underwent prehospital cardiopulmonary resuscitation (CPR). On ED arrival, the initial ETCO(2) measurement from the patient's endotracheal tube was immediately obtained prior to purposeful intervention in the patient's ventilation by using an Oridion Surestream Sure VentLine H Set with a Welch Allyn Propaq CS monitor. For each patient, the treating physician documented the ETCO(2) measurement, patient demographics, and details of the transport. The primary outcome was an abnormal ETCO(2) value (<30 mmHg or >45 mmHg). The secondary outcome was mortality.

RESULTS

One hundred eligible patients were enrolled, with a median age of 30 years (interquartile range [IQR] 15, 48 years). Esophageal intubations were identified in four cases, and those cases were excluded from further analysis. Mechanisms included trauma, 74; medical, 12; and burn, 10. The median ETCO(2) value was 32 mmHg (IQR 27, 38 mmHg), range 18-80 mmHg. Forty-six of 96 (48%, 95% confidence interval [CI] 38%, 58%) patients had abnormal ETCO(2) values, including 37 (39%, 95% CI 29%, 49%) with low ETCO(2) levels and nine (9%, 95% CI 4%, 17%) with high ETCO(2) levels. Death was higher in those trauma patients with abnormal ETCO(2) levels (10/33, 30%, 95% CI 16%, 49%) than in those with normal ETCO(2) levels (2/41, 5%, 95% CI 0.6%, 17%), relative risk = 6.2 (95% CI 1.5, 26.4), p = 0.004.

CONCLUSION

Nearly half of all patients transported by prehospital providers had abnormal ETCO(2) measurements on initial ED presentation, suggesting an area for potential improvement. Trauma patients with abnormal initial ETCO(2) levels were more likely to die.

摘要

背景

在创伤患者中，未经控制的研究表明，院前插管的应用存在不良结局，这可能与插管后通气不当有关。

目的

本研究旨在 1）在患者到达急诊部（ED）时即刻确定院前插管患者中存在异常呼气末二氧化碳（ETCO2）水平的比例，以及 2）描述 ED 到达时异常 ETCO2 水平与死亡率之间的关系。

方法

这是一项针对院前插管患者的前瞻性观察性队列研究。如果患者接受了院前心肺复苏（CPR），则将其排除在外。患者到达 ED 时，使用带有 Welch Allyn Propaq CS 监测器的 Oridion Surestream Sure VentLine H Set 立即从患者的气管内导管获得初始 ETCO2 测量值，在此之前，患者通气情况没有经过干预。对于每位患者，主治医生记录 ETCO2 测量值、患者人口统计学信息和转运细节。主要结局为异常 ETCO2 值（<30 mmHg 或 >45 mmHg）。次要结局为死亡率。

结果

共纳入 100 例符合条件的患者，中位年龄为 30 岁（四分位距 [IQR] 15，48 岁）。4 例患者存在食管插管，这些病例被排除在进一步分析之外。发病机制包括创伤 74 例、医疗 12 例和烧伤 10 例。中位 ETCO2 值为 32 mmHg（IQR 27，38 mmHg），范围 18-80 mmHg。96 例患者中有 46 例（48%，95%置信区间 [CI] 38%，58%）的 ETCO2 值异常，包括 37 例（39%，95% CI 29%，49%）的 ETCO2 水平较低和 9 例（9%，95% CI 4%，17%）的 ETCO2 水平较高。异常 ETCO2 水平的创伤患者死亡率（10/33，30%，95% CI 16%，49%）高于 ETCO2 水平正常的患者（2/41，5%，95% CI 0.6%，17%），相对风险=6.2（95% CI 1.5，26.4），p=0.004。