Green Robert S, Butler Michael B, Erdogan Mete
From the Department of Critical Care (R.S.G., M.B.B.), Dalhousie University, Halifax, NS, Canada; and Trauma Nova Scotia, Nova Scotia Department of Health and Wellness (R.S.G., M.E.), Halifax, NS, Canada.
J Trauma Acute Care Surg. 2017 Oct;83(4):569-574. doi: 10.1097/TA.0000000000001561.
Postintubation hypotension (PIH) is common and associated with poor outcomes in critically ill patient populations requiring emergency endotracheal intubation (ETI). The importance of PIH in the trauma population remains unclear. The objective of this study was to determine the prevalence of PIH in trauma patients and assess the association of PIH with patient outcomes.
Retrospective case series of adult (≥16 years) patients who were intubated on arrival at a tertiary trauma center in Halifax, Nova Scotia, Canada, between 2000 and 2015. Data were collected from the Nova Scotia Trauma Registry and patient chart, and included demographics, comorbidities, trauma characteristics, intubation time, as well as all fluids, medications, adverse events, interventions, and vital signs during the 15 minutes before/after ETI. We evaluated the prevalence of PIH and created a logistic regression model to determine likelihood of mortality in the PIH and non-PIH groups after controlling for patient and provider characteristics.
Overall, 477 patients required ETI on assessment by the trauma service, of which 444 patients met eligibility criteria and were included in the analysis. The prevalence of PIH was 36.3% (161 of 444) in our study population. In-hospital mortality occurred in 29.8% (48 of 161) of patients in the PIH group, compared with 15.9% (45 of 283) of patients in the non-PIH group (p = 0.001). Development of PIH was associated with increased mortality in the emergency department (adjusted odds ratio, 3.45; 95% confidence interval, 1.42-8.36) and in-hospital (adjusted odds ratio, 1.83; 95% confidence interval, 1.01-3.31).
In our study of trauma patients requiring ETI, development of PIH was common (36.3%) and associated with increased mortality. Intubation practices in critically ill trauma patients is an important patient safety issue that requires further investigation.
Prognostic and epidemiological, level III; Level IV, Therapeutic.
插管后低血压（PIH）很常见，并且在需要紧急气管插管（ETI）的危重症患者群体中与不良预后相关。PIH在创伤患者群体中的重要性仍不明确。本研究的目的是确定创伤患者中PIH的患病率，并评估PIH与患者预后的相关性。
对2000年至2015年间抵达加拿大新斯科舍省哈利法克斯一家三级创伤中心时接受插管的成年（≥16岁）患者进行回顾性病例系列研究。数据从新斯科舍省创伤登记处和患者病历中收集，包括人口统计学、合并症、创伤特征、插管时间，以及ETI前后15分钟内的所有液体、药物、不良事件、干预措施和生命体征。我们评估了PIH的患病率，并创建了一个逻辑回归模型，以确定在控制患者和医疗服务提供者特征后PIH组和非PIH组的死亡可能性。
总体而言，477例患者经创伤服务评估需要进行ETI，其中444例患者符合纳入标准并被纳入分析。在我们的研究人群中，PIH的患病率为36.3%（444例中的161例）。PIH组29.8%（161例中的48例）的患者发生院内死亡，而非PIH组为15.9%（283例中的45例）（p = 0.001）。PIH的发生与急诊科死亡率增加相关（调整后的优势比，3.45；95%置信区间，1.42 - 8.36）以及院内死亡率增加相关（调整后的优势比，1.83；95%置信区间，1.01 - 3.31）。
在我们对需要ETI的创伤患者的研究中，PIH的发生很常见（36.3%）且与死亡率增加相关。危重症创伤患者的插管操作是一个重要的患者安全问题，需要进一步研究。
预后和流行病学，三级；治疗，四级。
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