Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
Air Med J. 2021 Sep-Oct;40(5):312-316. doi: 10.1016/j.amj.2021.05.009. Epub 2021 Jul 2.
Rapid sequence intubation (RSI) is often required in managing critically ill patients in the prehospital setting. Although etomidate is a commonly used induction agent for RSI, ketamine has gained new interest in prehospital management with reported neutral hemodynamic effects. Limited data exist to support ketamine as an alternative to etomidate, particularly in the prehospital setting. The purpose of this study was to evaluate hemodynamic changes after the administration of ketamine versus etomidate in prehospital RSI.
This retrospective study evaluated adult patients undergoing prehospital RSI over 13 months within a regional emergency transport medicine service. Hypotension was defined as a 20% decrease in systolic blood pressure (SBP) within 15 minutes of receiving ketamine or etomidate. Hemodynamic data were collected 15 minutes before and 15 minutes after administration or until additional sedative medications were given. Data were analyzed using SPSS software (Version 21; IBM Corp, Armonk, NY), with P < .05 considered significant.
One hundred thirteen patients met the inclusion criteria (ketamine, n = 33; etomidate, n = 80), with the primary reasons for intubation being respiratory failure and trauma. There was no difference between the incidence of patients who experienced a 20% decrease in SBP (16% etomidate vs. 18% ketamine, P = .79). There were no significant differences in SBP pre- to postadministration between ketamine and etomidate.
No hemodynamic differences occurred between patients who received ketamine versus etomidate for prehospital RSI. Neither drug was associated with an increased need for additional sedatives, and neither drug was associated with an increased first-pass intubation success rate. Larger, prospective, powered studies are required to identify patients who may benefit from either ketamine or etomidate.
在院前环境中处理危重症患者时，通常需要快速序贯插管（RSI）。虽然依托咪酯是 RSI 常用的诱导剂，但氯胺酮在院前管理中引起了新的关注，其具有中性的血液动力学效应。支持氯胺酮作为依托咪酯替代药物的数据有限，特别是在院前环境中。本研究旨在评估院前 RSI 中给予氯胺酮与依托咪酯后血液动力学变化。
本回顾性研究评估了在区域紧急转运医学服务中，在 13 个月内接受院前 RSI 的成年患者。低血压定义为接受氯胺酮或依托咪酯后 15 分钟内收缩压（SBP）下降 20%。在给予药物前 15 分钟和给予药物后 15 分钟收集血液动力学数据，或直至给予其他镇静药物时。使用 SPSS 软件（版本 21；IBM 公司，纽约州阿蒙克）分析数据，P<.05 被认为具有统计学意义。
113 名患者符合纳入标准（氯胺酮组，n=33；依托咪酯组，n=80），插管的主要原因是呼吸衰竭和创伤。接受依托咪酯和氯胺酮的患者中，SBP 下降 20%的发生率无差异（依托咪酯组 16%，氯胺酮组 18%，P=0.79）。氯胺酮和依托咪酯给药前后 SBP 无显著差异。
院前 RSI 中，接受氯胺酮与依托咪酯的患者之间没有发生血液动力学差异。两种药物均与需要额外镇静剂的风险增加无关，也与首次插管成功率的增加无关。需要更大、前瞻性、有影响力的研究来确定可能受益于氯胺酮或依托咪酯的患者。
