Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia.
Emerg Med Australas. 2021 Oct;33(5):857-867. doi: 10.1111/1742-6723.13742. Epub 2021 Feb 9.
Rapid sequence intubation (RSI) is a core critical care skill. Emergency medicine trainees are exposed to relatively low numbers of RSIs. We aimed to improve patient outcomes by implementing an RSI checklist, electronic learning and audit, in line with current best evidence.
Prospective observational study of RSIs performed in the EDs of two Queensland hospitals between January 2014 and December 2016. Data collected included: first-pass success (FPS), predicted difficulty, indication for intubation, drugs used, positioning, number of attempts, checklist use and complications. Descriptive statistics and multivariable modelling were used to describe differences in FPS, and complications.
Six hundred and fifty-five patients underwent RSI with FPS of 86.6%. Complications were reported in 15.9%, mainly hypotension (10.9%) and desaturation (4.0%). FPS improved with bougie use (88.9% vs 73.0% without bougie, P < 0.001) and video-laryngoscopy (88.2% vs 72.9% using standard laryngoscopy, P < 0.001). New desaturation was reduced with apnoeic oxygenation (2.0% vs 22.2%, P < 0.001), bougie use (2.8% vs 8.9%, P < 0.001), checklist use (2.3% vs 22.7%, P < 0.001) and achieving FPS (2.1% vs 16.3%, P < 0.001). Complications were reduced with checklist use (13.3% vs 43.2%, P < 0.001) and apnoeic oxygenation use (3.9% vs 31.1%, P < 0.001). Logistic regression found checklist use was associated with reduced desaturation (OR 0.1, 95% CI 0.04-0.27) and the composite variable of any complication (OR 0.39, 95% CI 0.17-0.89).
Implementation of an evidence-based care bundle and audit of practice has created a safe environment for trainees to learn the core critical care skill of RSI. In our setting, checklist use was associated with fewer complications.
快速序贯插管（RSI）是一项核心的重症监护技能。急诊医学学员接触的 RSI 例数相对较少。我们旨在通过实施 RSI 检查表、电子学习和审核，以符合当前最佳证据，从而改善患者结局。
本前瞻性观察性研究于 2014 年 1 月至 2016 年 12 月在昆士兰州的两家医院的急诊科进行，对 RSI 进行了研究。收集的数据包括：首次通过成功率（FPS）、预计难度、插管指征、使用的药物、体位、尝试次数、检查表使用和并发症。使用描述性统计和多变量模型来描述 FPS 和并发症的差异。
共 655 例患者接受 RSI，FPS 为 86.6%。报告了 15.9%的并发症，主要为低血压（10.9%）和低氧血症（4.0%）。FPS 随着使用引导管（88.9% vs 73.0%无引导管，P < 0.001）和视频喉镜（88.2% vs 72.9%使用标准喉镜，P < 0.001）而提高。使用无通气给氧（2.0% vs 22.2%，P < 0.001）、引导管（2.8% vs 8.9%，P < 0.001）、检查表（2.3% vs 22.7%，P < 0.001）和实现 FPS（2.1% vs 16.3%，P < 0.001）可减少新出现的低氧血症。检查表使用（13.3% vs 43.2%，P < 0.001）和无通气给氧使用（3.9% vs 31.1%，P < 0.001）降低了并发症发生率。Logistic 回归发现检查表的使用与低氧血症（OR 0.1，95%CI 0.04-0.27）和任何并发症的复合变量（OR 0.39，95%CI 0.17-0.89）减少相关。
实施基于证据的护理措施，并对实践进行审核，为学员学习 RSI 这一核心重症监护技能创造了一个安全的环境。在我们的环境中，检查表的使用与并发症的减少相关。
