University of California, San Francisco-Fresno, Fresno, California, USA.
J Trauma Acute Care Surg. 2012 Dec;73(6):1401-5. doi: 10.1097/TA.0b013e318270dcf5.
In the emergency department (ED) of a teaching hospital, rapid sequence intubation (RSI) is performed by physicians with a wide range of experience. A variety of medications have been used for RSI, with potential for inadequate or excessive dosing as well as complications including hypotension and the need for redosing. We hypothesized that the use of a standardized RSI medication protocol has facilitated endotracheal intubation requiring less medication redosing and less medication-related hypotension.
An RSI medication protocol (ketamine 2 mg/kg intravenously administered and rocuronium 1 mg/kg intravenously administered, or succinylcholine 1.5 mg/kg intravenously administered) was implemented for all trauma patients undergoing ED intubation at a Level I trauma center. We retrospectively reviewed patients for the 1-year period before (PRE) and after (KET) the protocol was instituted. Data collected included age, sex, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) score of the head/face, AIS score of the chest, RSI drugs, need for redosing, time to intubation, indication for RSI, and number of RSI attempts.
During the study period, 439 patients met inclusion criteria; 266 without protocol (PRE) and 173 with protocol (KET). Patients were severely injured with a mean ISS of 24 and median AIS score of the head/face of 3. Dosing in the KET group was appropriate with a mean dose of 1.9-mg/kg ketamine administered. Compliance after KET introduction approached 90%. Fifteen patients in the PRE group required redosing of medication versus three in the KET group (p < 0.05, χ). For patients younger than 14 years, (26 in PRE and 10 in KET), 2 patients in the PRE group required redosing and none in the KET group (not significant). In all patients, mean time from drug administration to intubation decreased from 4 minutes to 3 minutes.
A standardized medication protocol simplifies RSI and allows efficient airway management of critically injured trauma patients in the ED of a teaching hospital. Incorporation of ketamine avoids potential complications of other commonly used RSI medications.
Therapeutic study, level IV.
在教学医院的急诊科，经验丰富程度各异的医师进行快速序贯插管（RSI）。各种药物已用于 RSI，可能存在剂量不足或过量以及包括低血压和需要再次给药在内的并发症。我们假设使用标准化的 RSI 药物方案有助于简化气管插管，减少药物再次给药的需求，并减少与药物相关的低血压。
在一级创伤中心，对所有接受急诊科插管的创伤患者实施 RSI 药物方案（静脉给予 2mg/kg 氯胺酮和 1mg/kg 罗库溴铵，或静脉给予 1.5mg/kg 琥珀胆碱）。我们回顾性分析了在方案实施前后（KET）1 年期间的患者数据。收集的数据包括年龄、性别、损伤严重程度评分（ISS）、头部/面部的简明损伤评分（AIS）、胸部的 AIS 评分、RSI 药物、需要再次给药、插管时间、RSI 指征和 RSI 尝试次数。
在研究期间，共有 439 名患者符合纳入标准；266 名无方案（PRE）和 173 名有方案（KET）。患者伤势严重，平均 ISS 为 24，头部/面部的中位数 AIS 评分为 3。KET 组的剂量合理，平均给予 1.9mg/kg 氯胺酮。引入 KET 后，遵医嘱率接近 90%。PRE 组中有 15 名患者需要再次给药的药物剂量，而 KET 组中有 3 名（p<0.05，χ）。在年龄小于 14 岁的患者中（PRE 组 26 例，KET 组 10 例），PRE 组中有 2 名患者需要再次给药，而 KET 组中没有（无统计学意义）。在所有患者中，从给药到插管的平均时间从 4 分钟缩短到 3 分钟。
标准化的药物方案简化了 RSI，并允许对教学医院急诊科的严重创伤患者进行有效的气道管理。使用氯胺酮避免了其他常用 RSI 药物的潜在并发症。
治疗性研究，IV 级。
