Cai Anthony R, Hodgman Erica I, Kumar Puneet B, Sehat Alvand J, Eastman Alexander L, Wolf Steven E
From the Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas.
J Burn Care Res. 2017 Jan/Feb;38(1):e23-e29. doi: 10.1097/BCR.0000000000000457.
A significant proportion of patients appeared to arrive at our American Burn Association-verified burn center intubated without clear benefit. The current study aims to evaluate regional prehospital intubation practices and their outcomes. All consecutive admissions from November 2012 to June 2014 were reviewed for data points associated with intubation. Demographics and outcomes for patients who were intubated before arrival or within 24 hours of admission were compared using χ, Fisher's exact test, and the Kruskal-Wallis test as appropriate. During this period, 958 patients were admitted. Of these, 120 were intubated before arrival, and 91 survived their injuries. Of these 91 survivors, 45 were extubated within 2 days, suggesting unnecessary intubation rate in 37.5%. Intubation-related complications were roughly three times as common among those intubated before arrival (12.5% vs 4.4%). Patients intubated before arrival to our burn center had a shorter median duration of intubation (1.0 vs 4.0 days), median hospital LOS (5.0 vs 22.0 days), and median intensive care unit length of stay (3.0 vs 10.0 days). Furthermore, we found a significant difference in the pattern of ventilator support duration between those arriving intubated, with a median of 2.0 days, and those intubated at our burn center, with a median of 5.5 days. Patients intubated by pre burn center providers have shorter intubation durations and shorter hospitalizations, suggesting inappropriate use of resources. Impending loss of airway appears unlikely among patients with adequate gas exchange at the time of examination. The current criteria for prehospital intubation should be revised to more accurately identify those who truly benefit from advanced airway maneuvers.
相当一部分患者似乎在未明确获益的情况下，被送往我们经美国烧伤协会认证的烧伤中心时已进行气管插管。本研究旨在评估区域院前气管插管操作及其结果。回顾了2012年11月至2014年6月期间所有连续入院患者与气管插管相关的数据点。对于入院前或入院后24小时内进行气管插管的患者，根据情况使用χ检验、Fisher精确检验和Kruskal-Wallis检验比较其人口统计学特征和结局。在此期间，共收治958例患者。其中，120例在入院前已进行气管插管，91例受伤后存活。在这91名幸存者中，45例在2天内拔管，提示不必要插管率为37.5%。气管插管相关并发症在入院前插管患者中大约是其他患者的三倍（12.5%对4.4%）。入院前在我们烧伤中心插管的患者气管插管中位持续时间较短（1.0天对4.0天）、住院中位时间较短（5.0天对22.0天）以及重症监护病房中位住院时间较短（3.0天对10.0天）。此外，我们发现入院时已插管患者的呼吸机支持持续时间模式与在我们烧伤中心插管患者存在显著差异，前者中位时间为2.0天，后者中位时间为,5.5天。烧伤中心之前的医护人员插管的患者插管持续时间较短且住院时间较短，提示资源使用不当。在检查时气体交换充足的患者中，气道即将丧失的情况似乎不太可能发生。当前的院前气管插管标准应进行修订，以更准确地识别那些真正从高级气道操作中获益的患者。
