Department of Emergency Medicine, New York Presbyterian-Columbia University, New York, New York.
Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York.
J Emerg Med. 2020 Mar;58(3):407-412. doi: 10.1016/j.jemermed.2019.12.025. Epub 2020 Jan 22.
To our knowledge, no study has assessed the correlation of fraction of inspired oxygen (FiO) and end-tidal oxygen (EtO) values obtained from a gas analyzer during the preoxygenation period of rapid sequence intubation (RSI) to predict partial pressure of oxygen (PaO) among patients requiring intubation in the emergency department (ED).
The purpose of this study was to determine whether a simple equation using EtO and FiO at time of induction could reliably estimate minimal PaO in ED patients undergoing RSI.
We conducted an observational pilot study performed in an adult ED utilizing a gas analyzer to obtain EtO and FiO values in ED patients undergoing RSI from data collectors blinded to our objective. The Pearson correlation coefficient was calculated between the equation's predicted PaO and the PaO drawn from an arterial blood gas shortly after intubation. A Bland-Altman plot analysis was performed to identify any additional bias.
Seventy-five patients were enrolled. The equation's mean predicted minimal PaO and mean PaO from an arterial blood gas within 3 min after intubation was 178 mm Hg (95% confidence interval [CI] 145-211 mm Hg) and 209 mm Hg (95% CI 170-258 mm Hg), respectively. The Pearson correlation coefficient between the predicted minimal PaO and post-intubation PaO demonstrated a strong correlation (r = 0.89). The Bland-Altman plot indicated no bias affecting the correlation between the predicted and actual PaO.
Among ED patients undergoing RSI, the use of a gas analyzer to measure EtO and FiO can provide a reliable measure of the minimal PaO at the time of induction during the RSI phase of preoxygenation.
据我们所知，尚无研究评估在急诊快速序贯诱导（RSI）预充氧期间从气体分析仪获得的吸入氧分数（FiO）和呼气末氧（EtO）值与需要插管的急诊科（ED）患者的氧分压（PaO）之间的相关性。
本研究旨在确定在接受 RSI 的 ED 患者中，诱导时使用 EtO 和 FiO 的简单方程是否能可靠地估计最小 PaO。
我们进行了一项观察性初步研究，在成人 ED 中利用气体分析仪从数据收集器获取接受 RSI 的 ED 患者的 EtO 和 FiO 值，这些数据收集器对我们的目的不知情。计算了方程预测的 PaO 与插管后不久从动脉血气中获得的 PaO 之间的 Pearson 相关系数。进行 Bland-Altman 图分析以确定任何额外的偏倚。
共纳入 75 例患者。方程预测的最小 PaO 和插管后 3 分钟内的动脉血气 PaO 的平均值分别为 178mmHg（95%CI 145-211mmHg）和 209mmHg（95%CI 170-258mmHg）。预测的最小 PaO 与插管后 PaO 之间的 Pearson 相关系数显示出很强的相关性（r=0.89）。Bland-Altman 图表明没有偏倚影响预测 PaO 与实际 PaO 之间的相关性。
在接受 RSI 的 ED 患者中，使用气体分析仪测量 EtO 和 FiO 可以可靠地估计 RSI 预充氧期间诱导时的最小 PaO。
