University of Rochester Medical Center-coordinating site., 601 Elmwood Ave. Box 638, Rochester, NY 14642, United States.
J Crit Care. 2018 Jun;45:65-70. doi: 10.1016/j.jcrc.2018.01.017. Epub 2018 Mar 23.
Characterize medication practices during and immediately after rapid sequence intubation (RSI) by provider/location and evaluate adverse drug events.
This was a multicenter, observational, cross-sectional study of adult and pediatric intensive care unit and emergency department patients over a 24-h period surrounding first intubation.
A total of 404 patients from 34 geographically diverse institutions were included (mean age 58 ± 22 years, males 59%, pediatric 8%). During RSI, 21%, 87%, and 77% received pre-induction, induction, and paralysis, respectively. Significant differences in medication use by provider type were seen. Etomidate was administered to 58% with sepsis, but was not associated with adrenal insufficiency. Ketamine was associated with hypotension post-RSI [RR = 1.78 (1.36-2.35)] and use was low with traumatic brain injury/stroke (1.5%). Succinylcholine was given to 67% of patients with baseline bradycardia and was significantly associated with bradycardia post-RSI [RR = 1.81 (1.11-2.94)]. An additional 13% given succinylcholine had contraindications. Sedation practices post-RSI were not consistent with current practice guidelines and most receiving a non-depolarizing paralytic did not receive adequate sedation post-RSI.
Medication practices during RSI vary amongst provider and medications are often used inappropriately. There is opportunity for optimization of medication use during RSI.
通过提供者/地点描述快速序贯插管（RSI）期间和之后的用药情况，并评估药物不良事件。
这是一项多中心、观察性、横断面研究，研究对象为在首次插管前后 24 小时内的成人和儿科重症监护病房和急诊科患者。
共有来自 34 个地理位置不同的机构的 404 名患者入选（平均年龄 58±22 岁，男性占 59%，儿科患者占 8%）。在 RSI 期间，分别有 21%、87%和 77%的患者接受了诱导前、诱导和麻痹药物。不同提供者类型的用药差异显著。在发生脓毒症的患者中，有 58%的患者给予了依托咪酯，但并未导致肾上腺功能不全。在 RSI 后，与低血压相关的药物是氯胺酮（RR=1.78[1.36-2.35]），且在创伤性脑损伤/中风患者中使用较少（1.5%）。有 67%的基线心动过缓患者给予了琥珀胆碱，并且与 RSI 后心动过缓显著相关（RR=1.81[1.11-2.94]）。另有 13%的患者使用琥珀胆碱存在禁忌证。RSI 后镇静药物的使用不符合当前的实践指南，大多数接受非去极化肌松剂的患者在 RSI 后未得到足够的镇静。
RSI 期间的用药情况因提供者而异，且药物的使用往往不恰当。在 RSI 期间优化药物使用有很大的空间。
