Koenig Seth J, Lakticova Viera, Narasimhan Mangala, Doelken Peter, Mayo Paul H
Division of Pulmonary, Critical Care, and Sleep Medicine, Long Island Jewish Medical Center, Hofstra North-Shore-LIJ School of Medicine, New Hyde Park, NY, USA
Division of Pulmonary, Critical Care, and Sleep Medicine, Long Island Jewish Medical Center, Hofstra North-Shore-LIJ School of Medicine, New Hyde Park, NY, USA.
J Intensive Care Med. 2015 Dec;30(8):499-504. doi: 10.1177/0885066614523100. Epub 2014 Feb 17.
Propofol is known to provide excellent intubation conditions without the use of neuromuscular blocking agents. However, propofol has adverse effects that may limit its use in the critically ill patients, particularly in the hemodynamically unstable patient. We report on the safety and efficacy of propofol for use as an agent for urgent endotracheal intubation (UEI) in the critically ill patients.
We reviewed the outcomes of 472 consecutive UEIs performed by a medical intensive care unit (ICU) team at a tertiary care hospital from November 2008 through November 2012. Outcome data were collected prospectively as part of an ongoing quality improvement project.
Propofol was used as the sole sedative agent in 409 (87%) of the 472 patients. In 18 (4%) of the 472 patients, other agents (midazolam, lorazepam, or etomidate) were used in addition to propofol. Of the 472, 10 (2%) intubations were performed with a sedative agent other than propofol, and 35 (7%) of the 472 intubations were performed without any sedating agent. Endotracheal tube insertion was successful in all 472 patients. Complications of UEI in those patients who received propofol were as follows: desaturation (Sao 2 < 80%) 30 (7%) of the 427, hypotension (systolic blood pressure < 70 mm Hg) 19 (4%) of the 427, difficult intubation (>2 attempts) 44 (10%) of the 427, esophageal intubation 24 (6%) of the 427, aspiration 6 (1%) of the 427, and oropharyngeal injury 4 (1%) of the 427. There were no deaths. Average dose of propofol was 99 mg (standard deviation 7.39) per person.
Our results compare favorably with the complication rate of UEI reported in the critical care and anesthesiology literature and indicate that propofol is a useful agent for airway management in the ICU.
已知丙泊酚在不使用神经肌肉阻滞剂的情况下能提供良好的插管条件。然而，丙泊酚存在不良反应，这可能会限制其在重症患者，尤其是血流动力学不稳定患者中的应用。我们报告丙泊酚作为重症患者紧急气管插管（UEI）药物的安全性和有效性。
我们回顾了2008年11月至2012年11月期间一家三级医院的医疗重症监护病房（ICU）团队连续进行的472例UEI的结果。作为正在进行的质量改进项目的一部分，前瞻性收集结果数据。
472例患者中有409例（87%）将丙泊酚用作唯一的镇静剂。472例患者中有18例（4%）除丙泊酚外还使用了其他药物（咪达唑仑、劳拉西泮或依托咪酯）。472例中，10例（2%）插管使用了丙泊酚以外的镇静剂，472例插管中有35例（7%）未使用任何镇静剂。472例患者气管插管均成功。接受丙泊酚的患者UEI并发症如下：427例中有30例（7%）出现血氧饱和度降低（Sao₂<80%），427例中有19例（4%）出现低血压（收缩压<70 mmHg），427例中有44例（10%）插管困难（>2次尝试），427例中有24例（6%）出现食管插管，427例中有6例（1%）出现误吸，427例中有4例（1%）出现口咽损伤。无死亡病例。丙泊酚的平均剂量为每人99 mg（标准差7.39）。
我们的结果与重症监护和麻醉学文献中报道的UEI并发症发生率相比具有优势，表明丙泊酚是ICU气道管理的一种有用药物。
