Mora Alejandra G, Ganem Victoria J, Ervin Alicia T, Maddry Joseph K, Bebarta Vikhyat S
Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, TX 78234.
Mil Med. 2016 May;181(5 Suppl):145-51. doi: 10.7205/MILMED-D-15-00194.
U.S. Critical Care Air Transport Teams (CCATTs) evacuate critically ill patients with acute pain in the combat setting. Limited data have been reported on analgesic administration en route, and no study has reported analgesic use by CCATTs. Our objective was to describe analgesics used by CCATTs for nonintubated, critically ill patients during evacuation from a combat setting.
We conducted an institutional review board-approved, retrospective review of CCATT records. We included nonintubated, critically ill patients who were administered analgesics in flight and were evacuated out of theater (2007-2012). Demographics, injury description, analgesics and anesthetics, and predefined clinical adverse events were recorded. Data were presented as mean ± standard deviation or percentage (%).
Of 1,128 records, we analyzed 381 subjects with the following characteristics: age 26 ± 7.0 years; 98% male; and 97% trauma (70% blast, 17% penetrating, 11% blunt, and 3% burn). The injury severity score was 19 ± 9. Fifty-one percent received morphine, 39% hydromorphone, 15% fentanyl, and 5% ketamine. Routes of delivery were 63% patient-controlled analgesia (PCA), 32% bolus intravenous (IV) administration, 24% epidural delivery, 21% continuous IV infusions, and 9% oral opioids. Patients that were administered local anesthetics (nerve block or epidural delivery) with IV opioids received a lower total dose of opioids than those who received opioids alone. No differences were associated between analgesics and frequency of complications in flight or postflight.
About half of nonintubated, critically ill subjects evacuated out of combat by CCATT received morphine and more than half had a PCA. In our study, ketamine was not frequently used and pain scores were rarely recorded. However, we detected an opioid-sparing effect associated with local anesthetics (regional nerve blocks and epidural delivery).
美国重症监护空中运输团队（CCATTs）在战斗环境中转运患有急性疼痛的重症患者。关于途中镇痛药物使用的数据报道有限，且尚无研究报告CCATTs的镇痛药物使用情况。我们的目的是描述CCATTs在从战斗环境转运非插管重症患者过程中使用的镇痛药物。
我们对CCATT记录进行了机构审查委员会批准的回顾性研究。纳入在飞行途中接受镇痛药物治疗并撤离战区的非插管重症患者（2007 - 2012年）。记录人口统计学信息、损伤描述、镇痛药物和麻醉药物以及预先定义的临床不良事件。数据以平均值±标准差或百分比（%）表示。
在1128份记录中，我们分析了381名具有以下特征的受试者：年龄26±7.0岁；98%为男性；97%为创伤患者（70%为爆炸伤，17%为穿透伤，11%为钝挫伤，3%为烧伤）。损伤严重程度评分为19±9。51%的患者接受吗啡治疗，39%接受氢吗啡酮治疗，15%接受芬太尼治疗，5%接受氯胺酮治疗。给药途径为63%患者自控镇痛（PCA），32%静脉推注，24%硬膜外给药，21%静脉持续输注，9%口服阿片类药物。与单独接受阿片类药物的患者相比，同时接受局部麻醉药（神经阻滞或硬膜外给药）和静脉阿片类药物的患者阿片类药物总剂量较低。飞行途中或飞行后，镇痛药物与并发症发生频率之间无差异。
通过CCATT撤离战斗环境的非插管重症患者中，约一半接受了吗啡治疗，超过一半采用了PCA。在我们的研究中，氯胺酮使用不频繁，疼痛评分记录很少。然而，我们发现局部麻醉药（区域神经阻滞和硬膜外给药）具有阿片类药物节省效应。
