Smischney Nathan, Kashyap Rahul, Seisa Mohamed, Schroeder Darrell, Diedrich Daniel
Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States.
JMIR Res Protoc. 2018 Dec 7;7(12):e11101. doi: 10.2196/11101.
Endotracheal intubation can occur in up to 60% of critically ill patients. Despite the frequency with which endotracheal intubation occurs, the current practice is largely unknown. This is relevant, as advances in airway equipment (ie, video laryngoscopes) have become more prevalent, leading to possible improvement of care delivered during this process. In addition to new devices, a greater emphasis on airway plans and choices in sedation have evolved, although the influence on patient morbidity and mortality is largely unknown.
This study aims to derive and validate prediction models for immediate airway and hemodynamic complications of intensive care unit intubations.
A multicenter, observational, prospective study of adult critically ill patients admitted to both medical and surgical intensive care units (ICUs) was conducted. Participating ICU sites were located throughout eight health and human services regions of the United States for which endotracheal intubation was needed. A steering committee composed of both anesthesia and pulmonary critical care physicians proposed a core set of data variables. These variables were incorporated into a data collection form to be used within the multiple, participating ICUs across the United States during the time of intubation. The data collection form consisted of two basic components, focusing on airway management and hemodynamic management. The form was generated using RedCap and distributed to the participating centers. Quality checks on the dataset were performed several times with each center, such that they arrived at less than 10% missing values for each data variable; the checks were subsequently entered into a database.
The study is currently undergoing data analysis. Results are expected in November 2018 with publication to follow thereafter. The study protocol has not yet undergone peer review by a funding body.
The overall goal of this multicenter prospective study is to develop a scoring system for peri-intubation, hemodynamic, and airway-related complications so we can stratify those patients at greatest risk for decompensation as a result of these complications. This will allow critical care physicians to be better prepared in addressing these occurrences and will allow them to improve the quality of care delivered to the critically ill.
ClinicalTrials.gov NCT02508948; https://clinicaltrials.gov/ct2/show/NCT02508948 (Archived by WebCite at http://www.webcitation.org/73Oj6cTFu).
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11101.
在高达60%的重症患者中会发生气管插管。尽管气管插管很常见，但目前的操作情况在很大程度上尚不清楚。这一点很重要，因为气道设备（如视频喉镜）的进步已变得更为普遍，这可能会改善在此过程中提供的护理。除了新设备外，对气道计划和镇静选择的重视程度也有所提高，尽管其对患者发病率和死亡率的影响在很大程度上尚不清楚。
本研究旨在推导并验证针对重症监护病房插管后即刻气道和血流动力学并发症的预测模型。
对入住内科和外科重症监护病房（ICU）的成年重症患者进行了一项多中心、观察性、前瞻性研究。参与研究的ICU分布在美国八个卫生和公共服务区域，这些区域的患者需要进行气管插管。由麻醉科和肺重症医学科医生组成的指导委员会提出了一组核心数据变量。这些变量被纳入一份数据收集表，以便在美国多个参与研究的ICU在插管时使用。数据收集表由两个基本部分组成，重点关注气道管理和血流动力学管理。该表格使用RedCap生成并分发给参与中心。每个中心对数据集进行了多次质量检查，以使每个数据变量的缺失值低于10%；随后将检查结果录入数据库。
该研究目前正在进行数据分析。预计2018年11月得出结果，随后发表。该研究方案尚未经过资助机构的同行评审。
这项多中心前瞻性研究的总体目标是开发一种针对插管围手术期、血流动力学和气道相关并发症的评分系统，以便我们能够对因这些并发症而发生失代偿风险最高的患者进行分层。这将使重症医学科医生在应对这些情况时能有更好的准备，并使他们能够提高为重症患者提供的护理质量。
ClinicalTrials.gov NCT02508948；https://clinicaltrials.gov/ct2/show/NCT02508948（由WebCite存档于http://www.webcitation.org/73Oj6cTFu）。
国际注册报告识别码（IRRID）：RR1-10.2196/11101。
