Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan.
Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA.
Am J Emerg Med. 2018 Nov;36(11):2044-2049. doi: 10.1016/j.ajem.2018.03.026. Epub 2018 Mar 14.
The anesthesia literature has reported that pre-intubation fentanyl use is associated with post-intubation hypotension which is a risk factor of poor post-emergency department (ED) prognosis. However, little is known about the relations between fentanyl use for intubation and post-intubation hypotension in the ED. We aimed to determine whether pretreatment with fentanyl was associated with a higher risk of post-intubation hypotension in the ED.
We conducted a secondary analysis of data of ED airway management collected from a multicenter prospective study of 14 Japanese EDs from February 2012 through November 2016. We included all adult non-cardiac-arrest patients who underwent rapid sequence intubation for medical indication. Patients were divided into fentanyl and non-fentanyl groups. The primary outcome was post-intubation hypotension (systolic blood pressure ≤90mmHg) in the ED.
Of 1263 eligible patients, 466 (37%) patients underwent pretreatment with fentanyl. The fentanyl group had a higher risk of post-intubation hypotension (17% vs. 6%; unadjusted OR, 1.73; 95%CI, 1.01-2.97; P=0.048) compared to the non-fentanyl group. In the multivariable analysis adjusting for age, sex, weight, principal indication, sedatives, intubator's specialty, number of intubation attempts, and patient clustering within EDs, the fentanyl group had a higher risk of post-intubation hypotension (adjusted OR, 1.87; 95%CI, 1.05-3.34; P=0.03) compared to the non-fentanyl group. In the sensitivity analysis using propensity score matching, this association remained significant (OR, 3.17; 95%CI, 1.96-5.14; P<0.01).
In this prospective multicenter study of ED airway management, pretreatment with fentanyl in rapid sequence intubation was associated with higher risks of post-intubation hypotension.
麻醉学文献报道，插管前使用芬太尼与插管后低血压有关，而后者是急诊（ED）预后不良的危险因素。然而，对于 ED 中芬太尼用于插管与插管后低血压之间的关系知之甚少。我们旨在确定 ED 中进行插管前预处理是否与插管后低血压的风险增加有关。
我们对 2012 年 2 月至 2016 年 11 月来自日本 14 个 ED 的多中心前瞻性研究中收集的 ED 气道管理数据进行了二次分析。我们纳入了所有因医学指征接受快速序贯插管的成年非心搏骤停患者。患者分为芬太尼组和非芬太尼组。主要结局是 ED 中的插管后低血压（收缩压≤90mmHg）。
在 1263 名符合条件的患者中，466 名（37%）患者接受了芬太尼预处理。与非芬太尼组相比，芬太尼组发生插管后低血压的风险更高（17%比 6%；未调整的 OR，1.73；95%CI，1.01-2.97；P=0.048）。在调整年龄、性别、体重、主要适应证、镇静剂、插管者专业、插管尝试次数以及 ED 内患者聚类后进行多变量分析，芬太尼组发生插管后低血压的风险高于非芬太尼组（调整 OR，1.87；95%CI，1.05-3.34；P=0.03）。在使用倾向评分匹配的敏感性分析中，这种关联仍然显著（OR，3.17；95%CI，1.96-5.14；P<0.01）。
在这项 ED 气道管理的前瞻性多中心研究中，快速序贯插管前使用芬太尼预处理与插管后低血压风险增加相关。
