Arulkumaran Nishkantha, McLaren Charles S, Arulkumaran Kailash, Philips Barbara J, Cecconi Maurizio
General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Intensive Care Medicine, Hillingdon Hospital Foundation Trust, London, UK.
J Intensive Care Soc. 2018 Aug;19(3):180-187. doi: 10.1177/1751143717749686. Epub 2018 Jan 17.
We evaluated intensive care medicine trainees' practice of emergency intubations in the United Kingdom.
Retrospective analysis of 881 in-hospital emergency intubations over a three-year period using an online trainee logbook.
Emergency intubations out-of-hours were less frequent than in-hours, both on weekdays and weekends. Complications occurred in 9% of cases, with no association with time of day/day of week (p = 0.860). Complications were associated with higher Cormack and Lehane grades (p=0.004) and number of intubation attempts (p < 0.001), but not American Society of Anesthesiologist grade. Capnography usage was ≥99% in all locations except in wards (85%; p = 0.001). Ward patients were the oldest (p < 0.001), had higher American Society of Anesthesiologist grades (p < 0.001) and lowest Glasgow Coma Scale (p < 0.001).
Complications of intubations are associated with higher Cormack and Lehane grades and number of attempts, but not time of day/day of week. The uptake of capnography is reassuring, although there is scope for improvement on the ward.
我们评估了英国重症医学实习生进行紧急气管插管的实践情况。
使用在线实习生日志对三年期间的881例院内紧急气管插管进行回顾性分析。
无论是在工作日还是周末，非工作时间的紧急气管插管都比工作时间少。9%的病例出现并发症，与一天中的时间/一周中的日期无关（p = 0.860）。并发症与较高的科马克和莱哈尼分级（p = 0.004）以及插管尝试次数有关（p < 0.001），但与美国麻醉医师协会分级无关。除病房外，所有地点的二氧化碳描记法使用率均≥99%（病房为85%；p = 0.001）。病房患者年龄最大（p < 0.001），美国麻醉医师协会分级较高（p < 0.001），格拉斯哥昏迷量表评分最低（p < 0.001）。
气管插管的并发症与较高的科马克和莱哈尼分级以及尝试次数有关，但与一天中的时间/一周中的日期无关。二氧化碳描记法的使用情况令人放心，尽管病房仍有改进空间。
