心脏手术后 ICU 内再次插管：是否比手术室首次插管更困难？：一项前瞻性观察研究。

Reintubation in the ICU following cardiac surgery: is it more difficult than first-time intubation in the operating room?: A prospective observational study.

机构信息

From the Department of Anesthesiology and Intensive Care Medicine, Clinical University Hospital of Santiago de Compostela, Santiago de Compostela, Spain (MT, RR, SM, RS-J, PM, SS, ME, AM, MR, AC, IR, SV, JA, AB) and The Department of Anesthesiology, University of Basel, Basel, Switzerland (PGA).

出版信息

Eur J Anaesthesiol. 2020 Jan;37(1):25-30. doi: 10.1097/EJA.0000000000001019.

DOI:10.1097/EJA.0000000000001019

PMID:31107352

Abstract

BACKGROUND

After cardiac surgery, a patient's trachea is usually extubated; however, 2 to 13% of cardiac surgery patients require reintubation in the ICU.

OBJECTIVE

The objective of this study was to compare the initial intubation in the cardiac operating room with reintubation (if required) in the ICU following cardiac surgery.

DESIGN

A prospective, observational study.

SETTING

Department of Anesthesiology and Intensive Care Medicine, Clinical Hospital of Santiago, Spain.

PATIENTS

With approval of the local ethics committee, over a 44-month period, we prospectively enrolled all cardiac surgical patients who were intubated in the operating room using direct laryngoscopy, and who required reintubation later in the ICU.

MAIN OUTCOME MEASURES

The primary endpoint was to compare first-time success rates for intubation in the operating room and ICU. Secondary endpoints were to compare the technical difficulties of intubation (modified Cormack-Lehane glottic view, operator-reported difficulty of intubation, need for support devices for direct laryngoscopy) and the incidence of complications.

RESULTS

A total of 122 cardiac surgical patients required reintubation in the ICU. Reintubation was associated with a lower first-time success rate than in the operating room (88.5 vs. 97.6%, P = 0.0048). Reintubation in the ICU was associated with a higher incidence of Cormack-Lehane grades IIb, III or IV views (34.5 vs. 10.7%, P < 0.0001), a higher incidence of moderate or difficult intubation (17.2 vs. 6.5%, P = 0.0001) and a greater need for additional support during direct laryngoscopy (20.5 vs. 10.7%, P = 0.005). Complications were more common during reintubations in the ICU (39.3 vs. 5.7%, P < 0.0001).

CONCLUSION

Compared with intubations in the operating room, reintubation of cardiac surgical patients in the ICU was associated with more technical difficulties and a higher incidence of complications.

CLINICAL TRIAL NUMBER

Ethics committee of Galicia number 2015-012.

摘要

背景

心脏手术后，患者的气管通常会被拔出；然而，2%至 13%的心脏手术患者需要在 ICU 重新插管。

目的

本研究旨在比较心脏手术患者在心脏手术室的初次插管与心脏手术后在 ICU 的再次插管（如果需要）。

设计

前瞻性观察研究。

地点

西班牙圣地亚哥临床医院麻醉科和重症监护病房。

患者

在当地伦理委员会批准的情况下，在 44 个月期间，我们前瞻性地纳入了所有在手术室使用直接喉镜插管且随后需要在 ICU 重新插管的心脏外科患者。

主要观察指标

主要终点是比较手术室和 ICU 初次插管的成功率。次要终点是比较插管的技术难度（改良的 Cormack-Lehane 声门视图、操作者报告的插管难度、对直接喉镜使用辅助设备的需求）和并发症的发生率。

结果

共有 122 例心脏外科患者需要在 ICU 重新插管。与手术室相比，再次插管的首次成功率较低（88.5% vs. 97.6%，P=0.0048）。在 ICU 进行再次插管时，Cormack-Lehane 分级 IIb、III 或 IV 级视图的发生率更高（34.5% vs. 10.7%，P<0.0001），中度或困难插管的发生率更高（17.2% vs. 6.5%，P=0.0001），对直接喉镜辅助的需求更大（20.5% vs. 10.7%，P=0.005）。在 ICU 进行再次插管时，并发症更常见（39.3% vs. 5.7%，P<0.0001）。