Smischney Nathan J, Seisa Mohamed O, Heise Katherine J, Wiegand Robert A, Busack Kyle D, Deangelis Jillian L, Loftsgard Theodore O, Schroeder Darrell R, Diedrich Daniel A
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States; Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States.
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States.
J Crit Care. 2018 Apr;44:179-184. doi: 10.1016/j.jcrc.2017.10.018. Epub 2017 Oct 16.
Our primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period.
We conducted a nested case-control study of a previously identified cohort of adult patients needing intubation admitted to a medical-surgical ICU during 2013-2014. Hemodynamic derangement was defined as cardiac arrest and/or the development of systolic blood pressure <90mmHg and/or mean arterial pressure <65mmHg 30min following intubation. Data during the peri-intubation period was analyzed.
The final cohort included 420 patients. Immediate hemodynamic derangement occurred in 170 (40%) patients. On multivariate modeling, age/10year increase (OR 1.20, 95% CI 1.03-1.39, p=0.02), pre-intubation non-invasive ventilation (OR 1.71, 95% CI 1.04-2.80, p=0.03), pre-intubation shock index/1 unit (OR 5.37 95% CI 2.31-12.46, p≤0.01), and pre-intubation modified shock index/1 unit (OR 2.73 95% CI 1.48-5.06, p≤0.01) were significantly associated with hemodynamic derangement. Those experiencing hemodynamic derangement had higher ICU [47 (28%) vs. 33 (13%); p≤0.001] and hospital [69 (41%) vs. 51 (20%); p≤0.001] mortality.
Hemodynamic derangement occurred at a rate of 40% and was associated with increased mortality. Increasing age, use of non-invasive ventilation before intubation, and increased pre-intubation shock and modified shock index values were significantly associated with hemodynamic derangement post-intubation.
我们的主要目的是确定插管期间即刻血流动力学失代偿的预测因素。
我们对2013年至2014年期间入住内科-外科重症监护病房的一组先前确定的需要插管的成年患者进行了一项巢式病例对照研究。血流动力学紊乱定义为插管后30分钟内心脏骤停和/或收缩压<90mmHg和/或平均动脉压<65mmHg。对插管期间的数据进行了分析。
最终队列包括420例患者。170例（40%）患者出现即刻血流动力学紊乱。多变量建模显示，年龄每增加10岁（比值比1.20，95%置信区间1.03-1.39，p=0.02）、插管前无创通气（比值比1.71，95%置信区间1.04-2.80，p=0.03）、插管前休克指数每增加1个单位（比值比5.37，95%置信区间2.31-12.46，p≤0.01）以及插管前改良休克指数每增加1个单位（比值比2.73，95%置信区间1.48-5.06，p≤0.01）与血流动力学紊乱显著相关。出现血流动力学紊乱的患者重症监护病房死亡率[47例（28%）对33例（13%）；p≤0.001]和医院死亡率[69例（41%）对51例（20%）；p≤0.001]更高。
血流动力学紊乱发生率为40%，且与死亡率增加相关。年龄增加、插管前使用无创通气以及插管前休克和改良休克指数值增加与插管后血流动力学紊乱显著相关。
