Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Crit Care Med. 2012 Jun;40(6):1808-13. doi: 10.1097/CCM.0b013e31824e0e67.
Emergent intubation is associated with a high rate of complications. Neuromuscular blocking agents are routinely used in the operating room and emergency department to facilitate intubation. However, use of neuromuscular blocking agents during emergent airway management outside of the operating room and emergency department is controversial. We hypothesized that the use of neuromuscular blocking agents is associated with a decreased prevalence of hypoxemia and reduced rate of procedure-related complications.
Five hundred sixty-six patients undergoing emergent intubations in two tertiary care centers, Massachusetts General Hospital, Boston, MA, and the University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA, were enrolled in a prospective, observational study. The 112 patients intubated during cardiopulmonary resuscitation were excluded, leaving 454 patients for analysis. All intubations were supervised by attendings trained in Critical Care Medicine. We measured intubating conditions, oxygen saturation during and 5 mins following intubation. We assessed the prevalence of procedure-related complications defined as esophageal intubation, traumatic intubation, aspiration, dental injury, and endobronchial intubation.
The use of neuromuscular blocking agents was associated with a lower prevalence of hypoxemia (10.1% vs. 17.4%, p = .022) and a lower prevalence of procedure-related complications (3.1% vs. 8.3%, p = .012). This association persisted in a multivariate analysis, which controlled for airway grade, sedation, and institution. Use of neuromuscular blocking agents was associated with significantly improved intubating conditions (laryngeal view, p = .014; number of intubation attempts, p = .049). After controlling for the number of intubation attempts and laryngoscopic view, muscle relaxant use is an independent predictor of complications associated with emergency intubation (p = .037), and there is a trend towards improvement of oxygenation (p = .07).
The use of neuromuscular blocking agents, when used by intensivists with a high level of training and experience, is associated with a decrease in procedure-related complications.
紧急插管与并发症的高发率相关。在手术室和急诊室中，神经肌肉阻滞剂常被用于辅助插管。然而，在手术室和急诊室之外进行紧急气道管理时使用神经肌肉阻滞剂仍存在争议。我们假设，使用神经肌肉阻滞剂与降低低氧血症的发生率和减少与操作相关的并发症发生率有关。
在马萨诸塞州总医院和加利福尼亚大学洛杉矶分校罗纳德·里根医疗中心这两个三级保健中心，566 名接受紧急插管的患者参与了一项前瞻性、观察性研究。排除了心肺复苏期间插管的 112 名患者，因此共有 454 名患者纳入分析。所有插管均由接受过重症监护医学培训的主治医生进行监督。我们测量了插管条件、插管期间和插管后 5 分钟时的氧饱和度。我们评估了与操作相关的并发症的发生率，这些并发症定义为食管插管、创伤性插管、误吸、牙损伤和支气管插管。
使用神经肌肉阻滞剂与低氧血症的发生率较低相关（10.1%比 17.4%，p =.022），与与操作相关的并发症发生率较低相关（3.1%比 8.3%，p =.012）。在控制气道分级、镇静和机构因素后，这种关联仍然存在于多变量分析中。使用神经肌肉阻滞剂与显著改善的插管条件相关（喉镜视野，p =.014；插管尝试次数，p =.049）。在控制插管尝试次数和喉镜视野后，肌肉松弛剂的使用是与紧急插管相关的并发症的独立预测因素（p =.037），并且存在改善氧合的趋势（p =.07）。
在具有高水平培训和经验的重症监护医生使用时，神经肌肉阻滞剂的使用与与操作相关的并发症发生率降低有关。
