Department of Anesthesiology, Thomas Jefferson University Hospital, Suite 8290 Gibbon, 111 South 11th Street, Philadelphia, PA 19107, USA.
Department of Anesthesiology, Johns Hopkins University Hospital, Baltimore, MD, USA.
BMC Anesthesiol. 2019 Dec 3;19(1):220. doi: 10.1186/s12871-019-0894-4.
Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward.
We retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained.
336 intubations were performed in 275 patients during the six-month period. The majority of intubations (n = 196, 58%) occurred in an ICU setting, and the rest 140 (42%) occurred on a normal floor or in a remote location. The mean admission ASA status was 3.6 ± 0.5, age 60 ± 16 years, and BMI 30 ± 9 kg/m. Chest X-rays performed immediately after intubation showed main stem intubation in 3.3% (n = 9). Two immediate (within 20 min after intubation) intubation related cardiac arrest/mortality events were identified. The 30-day in-hospital mortality was 31.6% (n = 87), the overall in-hospital mortality was 37.1% (n = 102), the mean hospital stay was 22 ± 20 days, and the mean ICU-stay was 14 days (13.9 ± 0.9, CI 12.1-15.8) with a 7.3% ICU-readmission rate.
Patients requiring emergent airway management are a high-risk patient population with multiple comorbidities and high ASA scores on admission. Only a small number of intubation-related complications were reported but ICU length of stay was high.
手术室外的紧急气道管理是一项高风险的操作。目前关于插管时患者的指征和生理状态、插管发生的位置或患者随后的结果的数据有限。
我们回顾性地收集了在 6 个月期间在手术室外进行的所有紧急气道管理干预的数据。记录包括插管操作、插管相关并发症和死亡率。还获得了其他信息，包括人口统计学、ASA 分类、合并症、住院时间、重症监护病房停留时间和 30 天院内死亡率。
在 6 个月期间，对 275 名患者进行了 336 次插管。大多数插管（n=196，58%）发生在重症监护病房，其余 140 次（42%）发生在普通病房或偏远地区。入院时 ASA 状态的平均值为 3.6±0.5，年龄为 60±16 岁，BMI 为 30±9kg/m。插管后立即进行的胸部 X 光检查显示，主支气管插管占 3.3%（n=9）。发现 2 例即刻（插管后 20 分钟内）与插管相关的心跳骤停/死亡率事件。30 天院内死亡率为 31.6%（n=87），总院内死亡率为 37.1%（n=102），平均住院时间为 22±20 天，平均重症监护病房停留时间为 14 天（13.9±0.9，CI 12.1-15.8），重症监护病房再入院率为 7.3%。
需要紧急气道管理的患者是一个高危人群，入院时存在多种合并症和高 ASA 评分。仅报告了少数与插管相关的并发症，但重症监护病房的住院时间较长。
