Fadhlillah Fiqry, Bury Sarah, Grocholski Ewa, Dean Mike, Refson Ali
Department of Emergency, London North West University Healthcare NHS Trust, Harrow, United Kingdom.
J Emerg Trauma Shock. 2020 Jan-Mar;13(1):58-61. doi: 10.4103/JETS.JETS_100_19. Epub 2020 Mar 19.
Endotracheal intubation in the critically unwell is a life-saving procedure, frequently performed in the emergency department (ED). The 4 National Audit Project (NAP4) of the Royal College of Anaesthetists and Difficult Airway Society, however, highlighted the deficiencies that could have led to serious harm. In direct response to NAP4, a 2018 guideline was published on the management of intubations in critically ill adults.
This study describes the current practice of endotracheal intubation, in comparison to the published 2018 guideline.
A retrospective observational study in an ED of a district general hospital in Greater London.
Adult attendances from September 1, 2017, to September 1, 2018 (>18 years old) fulfilling the search criteria were reviewed, producing 1553 case notes. These cases were individually reviewed by the authors.
Mann-Whitney U-test.
There were 94 intubations, male to female ratio 1.8:1. The most common indication was for airway protection ( = 35), followed by respiratory failure ( = 23). There were 31 first-pass intubation successes. Intensivists performed most of the intubations ( = 66), followed by anesthetists ( = 13), and ED physicians ( = 10), but with no significant difference between the response rates of ED and external physicians ( = 0.0477). Propofol was the induction drug of choice ( = 37), with rocuronium the paralyzing agent of choice ( = 42). Altogether, there were eight complications reported.
This study provides an overview of the intubation practices in a single-center ED. Non-ED physicians perform the majority of intubations, with a variety of induction and paralyzing agents being used. It adds to the growing call for better standardization and provision of care to patients with a deteriorating airway and the continued auditing of practice.
对危重症患者进行气管插管是一项挽救生命的操作，常在急诊科（ED）进行。然而，皇家麻醉师学院和困难气道协会的第4次全国审计项目（NAP4）强调了可能导致严重伤害的不足之处。作为对NAP4的直接回应，2018年发布了关于危重症成年患者插管管理的指南。
本研究描述了气管插管的当前实践，并与2018年发布的指南进行比较。
在大伦敦一家地区综合医院的急诊科进行的回顾性观察研究。
对2017年9月1日至2018年9月1日期间符合搜索标准的成年就诊患者（年龄>18岁）进行回顾，共产生1553份病例记录。作者对这些病例进行了逐一审查。
曼-惠特尼U检验。
共进行了94次插管，男女比例为1.8:1。最常见的指征是气道保护（n = 35），其次是呼吸衰竭（n = 23）。首次插管成功31例。重症监护医生进行了大部分插管操作（n = 66），其次是麻醉医生（n = 13）和急诊科医生（n = 10），但急诊科医生和外部医生的成功率无显著差异（P = 0.0477）。丙泊酚是首选的诱导药物（n = 37），罗库溴铵是首选的肌松剂（n = 42）。总共报告了8例并发症。
本研究概述了单中心急诊科的插管实践。非急诊科医生进行了大部分插管操作，使用了多种诱导和肌松药物。这进一步呼吁更好地规范气道恶化患者的护理，并持续对实践进行审计。
