Smischney Nathan J, Seisa Mohamed O, Heise Katherine J, Busack Kyle D, Loftsgard Theodore O, Schroeder Darrell R, Diedrich Daniel A
1 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
2 Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA.
J Intensive Care Med. 2017 Jan 1:885066617691495. doi: 10.1177/0885066617691495.
To describe the practice of intubation of the critically ill at a single academic institution, Mayo Clinic's campus in Rochester, Minnesota, and to report the incidence of immediate postintubation complications.
Critically ill adult (≥18 years) patients admitted to a medical-surgical intensive care unit from January 1, 2013, to December 31, 2014, who required endotracheal intubation included.
The final cohort included 420 patients. The mean age at intubation was 62.9 ± 16.3 years, with 58% (244) of the cohort as male. The most common reason for intubation was respiratory failure (282 [67%]). The most common airway device used was video laryngoscopy (204 [49%]). Paralysis was used in 264 (63%) patients, with ketamine as the most common sedative (194 [46%]). The most common complication was hypotension (170 [41%]; 95% confidence interval [CI]: 35.7-45.3) followed by hypoxemia (74 [17.6%]; 95% CI: 14.1-21.6), with difficult intubation occurring in 20 (5%; 95% CI: 2.9-7.3).
We found a high success rate of first-pass intubation in critically ill patients (89.8%), despite the procedure being done primarily by trainees 92.6% of the time; video was the preferred method of laryngoscopy (48.6%). Although our difficult intubation (4.8%) and complication rates typically associated with the act of intubation such as aspiration (1.2%; 95% CI: 0.4-2.8) and esophageal intubation (0.2%; 95% CI: 0.01-1.3) are very low compared to other published rates (8.09%), postintubation hypotension (40.5%) and hypoxemia (17.6%) higher.
描述明尼苏达州罗切斯特市梅奥诊所这一学术机构对重症患者进行插管操作的情况，并报告插管后即刻并发症的发生率。
纳入2013年1月1日至2014年12月31日期间入住内科 - 外科重症监护病房且需要气管插管的成年（≥18岁）重症患者。
最终队列包括420例患者。插管时的平均年龄为62.9±16.3岁，队列中58%（244例）为男性。插管最常见的原因是呼吸衰竭（282例[67%]）。最常用的气道设备是视频喉镜（204例[49%]）。264例（63%）患者使用了麻痹药物，其中氯胺酮是最常用的镇静剂（194例[46%]）。最常见的并发症是低血压（170例[41%]；95%置信区间[CI]：35.7 - 45.3），其次是低氧血症（74例[17.6%]；95%CI：14.1 - 21.6），插管困难发生在20例（5%；95%CI：2.9 - 7.3）。
我们发现重症患者首次插管成功率较高（89.8%），尽管该操作92.6%的时间主要由实习生完成；视频是首选的喉镜检查方法（48.6%）。虽然与其他已发表的发生率相比，我们的插管困难率（4.8%）以及通常与插管操作相关的并发症发生率，如误吸（1.2%；95%CI：0.4 - 2.8）和食管插管（0.2%；95%CI：0.01 - 1.3）非常低（8.09%），但插管后低血压（40.5%）和低氧血症（17.6%）发生率较高。
