新生儿插管时使用神经肌肉阻滞剂和镇静进行预给药与较少的不良事件相关。
Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.
机构信息
Center for simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
出版信息
J Perinatol. 2019 Jun;39(6):848-856. doi: 10.1038/s41372-019-0367-0. Epub 2019 Apr 2.
OBJECTIVE
To determine the impact of premedication for tracheal intubation (TI) on adverse TI associated events, severe oxygen desaturations, and first attempt success STUDY DESIGN: Retrospective cohort study in neonatal intensive care units (NICU) participating in the National Emergency Airway Registry for Neonates from 10/2014 to 6/2017. Premedication for TI was categorized as sedation with neuromuscular blockade, sedation only, or no medication.
RESULTS
2260 TIs were reported from 11 NICUs. Adverse TI associated events occurred less often in sedation with neuromuscular blockade group (10%) as compared to sedation only (29%), or no medication group (23%), p < 0.001. The adjusted odds ratio (aOR) for adverse TI associated events were: sedation with neuromuscular blockade aOR 0.48 (95%CI 0.34-0.65, p < 0.001) compared to no medication.
CONCLUSION
Use of sedation with neuromuscular blockade was associated with favorable TI outcomes. This study supports the recommendation for the standard use of sedation with neuromuscular blockade in non-emergency TIs.
目的
确定气管插管（TI）前用药对不良 TI 相关事件、严重氧饱和度下降和首次尝试成功的影响。
研究设计
参与国家新生儿急症气道登记研究的新生儿重症监护病房（NICU）的回顾性队列研究，时间为 2014 年 10 月至 2017 年 6 月。TI 前用药分为镇静联合神经肌肉阻滞剂、仅镇静或无药物治疗。
结果
来自 11 个 NICU 的 2260 例 TI 报告。与仅镇静（29%）或无药物治疗组（23%）相比，镇静联合神经肌肉阻滞剂组不良 TI 相关事件发生率较低（10%），p<0.001。不良 TI 相关事件的调整比值比（aOR）为：镇静联合神经肌肉阻滞剂 aOR 0.48（95%CI 0.34-0.65，p<0.001），与无药物治疗相比。
结论
使用镇静联合神经肌肉阻滞剂与有利的 TI 结果相关。这项研究支持在非紧急 TI 中常规使用镇静联合神经肌肉阻滞剂的建议。
Zotero 插件