Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre, France.
Anesth Analg. 2012 Oct;115(4):873-9. doi: 10.1213/ANE.0b013e31825f829d. Epub 2012 Jul 4.
Urgent tracheal intubations are common in intensive care units (ICU), and succinylcholine is one of the first-line neuromuscular blocking drugs used in these situations. Critically ill patients could be at high risk of hyperkalemia after receiving succinylcholine because one or more etiologic factors of nicotinic receptor upregulation can be present, but there are few data on its real risk. Our objectives in this study were to determine the factors associated with arterial potassium increase (ΔK) and to assess the occurrence of acute hyperkalemia ≥6.5 mmol/L after succinylcholine injection for intubation in the ICU.
In a prospective, observational study, all critically ill patients intubated with succinylcholine in an ICU were screened. Only intubations with arterial blood gases and potassium measurements before and after (K(after)) a succinylcholine injection were studied.
During 18 months, 131 critically ill patients were intubated after receiving succinylcholine with arterial potassium before and after intubation (K(after)) for a total of 153 intubations. After multivariate analysis, the only factor associated with ΔK was the length of ICU stay before intubation (ρ = 0.561, P < 0.001). The factors associated with K(after) ≥6.5 mmol/L (n = 11) were the length of ICU stay (P < 0.001) and the presence of acute cerebral pathology (P = 0.047). The threshold of 16 days was found highly predictive of acute hyperkalemia ≥6.5 with 37% (95% confidence interval: 19%-58%) of K(after) ≥6.5 after the 16th day compared with only 1% (95% confidence interval: 0%-4%) of K(after) ≥6.5 when succinylcholine was injected during the first 16 days.
This study shows that the risk of ΔK after succinylcholine injection is strongly associated with the length of ICU stay. The risk of acute hyperkalemia ≥6.5 mmol/L is highly significant after 16 days.
紧急气管插管在重症监护病房（ICU）中很常见，而琥珀胆碱是这些情况下使用的一线神经肌肉阻滞剂之一。接受琥珀胆碱后，危重症患者可能有发生高钾血症的高风险，因为可能存在一个或多个烟碱受体上调的病因因素，但关于其真实风险的数据很少。我们在这项研究中的目的是确定与动脉钾增加（ΔK）相关的因素，并评估 ICU 中接受琥珀胆碱插管后急性高钾血症（≥6.5mmol/L）的发生情况。
在一项前瞻性观察性研究中，对所有在 ICU 中接受琥珀胆碱插管的危重症患者进行了筛选。仅研究了在琥珀胆碱注射前后有动脉血气和钾测量值的插管（K（after））。
在 18 个月期间，共有 131 名危重症患者在接受琥珀胆碱插管后进行了动脉钾（K（after））的测量，共进行了 153 次插管。经过多变量分析，唯一与ΔK 相关的因素是插管前 ICU 住院时间（ρ=0.561，P<0.001）。与 K（after）≥6.5mmol/L（n=11）相关的因素是 ICU 住院时间（P<0.001）和急性脑病理（P=0.047）。发现 16 天的阈值对急性高钾血症（≥6.5mmol/L）具有高度预测性，第 16 天后 K（after）≥6.5 的比例为 37%（95%置信区间：19%-58%），而在第 16 天内注射琥珀胆碱时 K（after）≥6.5 的比例仅为 1%（95%置信区间：0%-4%）。
本研究表明，琥珀胆碱注射后ΔK 的风险与 ICU 住院时间密切相关。第 16 天后发生急性高钾血症（≥6.5mmol/L）的风险显著增加。
