一项多中心研究，旨在探讨创伤患者快速序贯气管插管诱导药物对血流动力学的影响。
A multicenter investigation of the hemodynamic effects of induction agents for trauma rapid sequence intubation.
机构信息
From the Department of Surgery and Perioperative Care (E.L., J.K., C.V.R.B., F.B.), Dell Medical School at the University of Texas at Austin, Austin; Division of Trauma and Acute Care Surgery 3 (C.W., A.K.), Ben Taub Hospital, Houston; Department of Surgery (A.J.R.T.), University Medical Center of El Paso, El Paso; Department of Surgery (A.C., L.A.), University of Texas Health Science Center at Tyler, Tyler; Department of Surgery (E.F., V.E.H.), University of Texas Health Science Center at Houston, Houston; Division of Acute Care Surgery (J.R.), Baylor Scott&White Medical Center-Temple, Temple; Department of Surgery (R.R., N.T.), University Medical Center, Lubbock; Department of Surgery (M.C.), Medical City Plano, Plano, Texas.
出版信息
J Trauma Acute Care Surg. 2021 Jun 1;90(6):1009-1013. doi: 10.1097/TA.0000000000003132.
BACKGROUND
Several options exist for induction agents during rapid sequence intubation (RSI) in trauma patients, including etomidate, ketamine, and propofol. These drugs have reported variable hemodynamic effects (hypotension with propofol and sympathomimetic effects with ketamine) that could affect trauma resuscitations. The purpose of this study was to compare the hemodynamic effects of these three induction agents during emergency department RSI in adult trauma. We hypothesized that these drugs would display a differing hemodynamic profile during RSI.
METHODS
We performed a retrospective (2014-2019), multicenter trial of adult (≥18 years) trauma patients admitted to eight ACS-verified Level I trauma centers who underwent emergency department RSI. Variables collected included systolic blood pressure (SBP) and pulse before and after RSI. The primary outcomes were change in heart rate and SBP before and after RSI.
RESULTS
There were 2,092 patients who met criteria, 85% received etomidate (E), 8% ketamine (K), and 7% propofol (P). Before RSI, the ketamine group had a lower SBP (E, 135 vs. K, 125 vs. P, 135 mm Hg, p = 0.04) but there was no difference in pulse (E, 104 vs. K, 107 vs. P, 105 bpm, p = 0.45). After RSI, there were no differences in SBP (E, 135 vs. K, 130 vs. P, 133 mm Hg, p = 0.34) or pulse (E, 106 vs. K, 110 vs. P, 104 bpm, p = 0.08). There was no difference in the average change of SBP (E, 0.2 vs. K, 5.2 vs. P, -1.8 mm Hg, p = 0.4) or pulse (E, 1.7 vs. K, 3.5 bpm vs. P, -0.96, p = 0.24) during RSI.
CONCLUSION
Contrary to our hypothesis, there was no difference in the hemodynamic effect for etomidate versus ketamine versus propofol during RSI in trauma patients.
LEVEL OF EVIDENCE
Therapeutic, Level IV.
背景
在创伤患者的快速序贯插管（RSI）中，有几种诱导剂可供选择，包括依托咪酯、氯胺酮和丙泊酚。这些药物具有不同的血流动力学效应（丙泊酚引起低血压，氯胺酮引起拟交感神经效应），可能会影响创伤复苏。本研究的目的是比较这三种诱导剂在成人创伤急诊 RSI 中的血流动力学效应。我们假设这些药物在 RSI 期间会表现出不同的血流动力学特征。
方法
我们进行了一项回顾性（2014-2019 年）、多中心研究，纳入了 8 家 ACS 认证的 I 级创伤中心收治的成年（≥18 岁）创伤患者，这些患者接受了急诊 RSI。收集的变量包括 RSI 前后的收缩压（SBP）和脉搏。主要结局为 RSI 前后心率和 SBP 的变化。
结果
符合标准的患者有 2092 例，85%接受依托咪酯（E），8%接受氯胺酮（K），7%接受丙泊酚（P）。RSI 前，氯胺酮组的 SBP 较低（E 组 135mmHg，K 组 125mmHg，P 组 135mmHg，p=0.04），但脉搏无差异（E 组 104bpm，K 组 107bpm，P 组 105bpm，p=0.45）。RSI 后，SBP 无差异（E 组 135mmHg，K 组 130mmHg，P 组 133mmHg，p=0.34）或脉搏无差异（E 组 106bpm，K 组 110bpm，P 组 104bpm，p=0.08）。RSI 期间 SBP（E 组 0.2mmHg，K 组 5.2mmHg，P 组-1.8mmHg，p=0.4）或脉搏（E 组 1.7bpm，K 组 3.5bpm，P 组-0.96bpm，p=0.24）的平均变化也无差异。
结论
与我们的假设相反，依托咪酯与氯胺酮与丙泊酚在创伤患者的 RSI 中血流动力学效应无差异。
证据水平
治疗，IV 级。
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