Badia M, Montserrat N, Serviá L, Baeza I, Bello G, Vilanova J, Rodríguez-Ruiz S, Trujillano J
Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España.
Universidad de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, España.
Med Intensiva. 2015 Jan-Feb;39(1):26-33. doi: 10.1016/j.medin.2014.01.003. Epub 2014 Mar 4.
A study is made to determine the characteristics of endotracheal intubation (ETI) procedures performed in an Intensive Care Unit, and to describe the associated severe complications and related risk factors.
A prospective cohort study involving a 2-year period was carried out.
The combined clinical/surgical Intensive Care Unit in a secondary university hospital.
All ETIs carried out by intensivists were included.
None.
We analyzed the data associated with the patient, the procedure and the postoperative complications after intubation. The study of risk factors was performed using multiple logistic regression analysis.
Seventy-six percent of the ETIs were performed immediately. Most of them were carried out by Intensive Care Units residents (60%). A total of 34% of the procedures had severe complications, including respiratory (16%) or hemodynamic (5%) disorders, or both (10%). Three patients died (1%), and 2% of the subjects experienced cardiac arrest. Logistic regression analysis identified the following independent risk factors for complications: age (OR 1.1; 95% CI: 1.1-1.2), systolic blood pressure≤90mmHg (OR 3.0; 95% CI: 1.4-6.4) and SpO2≤90% (OR 4.4; 95% CI: 2.3-8.1) prior to intubation, the presence of secretions (OR 2.2; 95% CI: 1.1-4.6), and the need for more than one ETI attempt (OR 3.5; 95% CI: 1.4-8.7).
ETI in Intensive Care Unit patients is associated with respiratory and hemodynamic complications. The independent risk factors associated with the development of complications were advanced age, hypotension and previous hypoxemia, the presence of secretions, and the need for more than one ETI attempt.
开展一项研究以确定重症监护病房（ICU）内气管插管（ETI）操作的特点，并描述相关的严重并发症及相关危险因素。
进行了一项为期2年的前瞻性队列研究。
一所二级大学医院的临床/外科联合重症监护病房。
纳入所有由重症监护医生实施的ETI操作。
无。
我们分析了与患者、操作及插管后术后并发症相关的数据。使用多元逻辑回归分析进行危险因素研究。
76%的ETI操作是立即进行的。其中大多数由重症监护病房住院医师实施（60%）。共有34%的操作出现严重并发症，包括呼吸（16%）或血流动力学（5%）紊乱，或两者皆有（10%）。3例患者死亡（1%），2%的受试者发生心脏骤停。逻辑回归分析确定了以下并发症的独立危险因素：插管前年龄（比值比[OR]1.1；95%置信区间[CI]：1.1 - 1.2）、收缩压≤90mmHg（OR 3.0；95% CI：1.4 - 6.4）和血氧饱和度（SpO2）≤90%（OR 4.4；95% CI：2.3 - 8.1）、存在分泌物（OR 2.2；95% CI：1.1 - 4.6）以及需要进行不止一次ETI尝试（OR 3.5；95% CI：1.4 - 8.7）。
重症监护病房患者的ETI操作与呼吸和血流动力学并发症相关。与并发症发生相关的独立危险因素为高龄、低血压和既往低氧血症、存在分泌物以及需要进行不止一次ETI尝试。
