Eggen Idunn Banschbach, Brønstad Gunhild, Langeland Halvor, Klepstad Pål, Nordseth Trond
Department of Circulation and Medical Imaging, Faculty of Medicine and Heath Sciences, Norwegian University of Science and Technology, No-7491 Trondheim, Norway.
Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, No-7030 Trondheim, Norway.
Resusc Plus. 2022 Mar 19;10:100221. doi: 10.1016/j.resplu.2022.100221. eCollection 2022 Jun.
Endotracheal suctioning (ETS) is required in critically ill patients but may lead to adverse physiologic effects. The aim of this study was to investigate risk factors associated with adverse respiratory and circulatory effects of ETS, in post-cardiac arrest patients receiving controlled ventilation.
Patients with return of spontaneous circulation after out-of-hospital cardiac arrest were followed the first five days in the intensive care unit (ICU). For each ETS procedure performed, data were extracted from the electronic ICU records 10 min before and until 30 min after the procedure. Adverse events were defined as heart rate > 120 beats/min, systolic blood pressure > 200 or < 80 mmHg or SpO < 85%. Multivariate logistic regression was applied with SpO < 85% and systolic blood pressure < 80 mmHg as primary outcomes.
For the 36 patients included in the study, the median number of ETS-procedures per patient was 13 (range 1-33). Oxygen desaturation occurred in 10.3% of procedures and severe hypotension in 6.6% of procedures. In the multivariate analysis, dose of noradrenaline, light sedation and oxygen desaturation prior to suctioning were associated with increased risk of oxygen desaturation. Doses of noradrenaline, suction with manual ventilation, suction in combination with patient repositioning, and first day of treatment in the ICU were significantly associated with severe hypotension.
The risk of circulatory and respiratory deterioration during ETS in post-cardiac arrest patients is increased the first day of ICU care, and related to sedation, dose of noradrenaline and pre-procedure hypoxemia.
危重症患者需要进行气管内吸痰（ETS），但这可能会导致不良生理效应。本研究的目的是调查在接受控制通气的心脏骤停后患者中，与ETS不良呼吸和循环效应相关的危险因素。
对院外心脏骤停后恢复自主循环的患者在重症监护病房（ICU）进行头五天的随访。对于每次进行的ETS操作，从电子ICU记录中提取操作前10分钟直至操作后30分钟的数据。不良事件定义为心率>120次/分钟、收缩压>200或<80 mmHg或SpO<85%。以SpO<85%和收缩压<80 mmHg作为主要结局，应用多因素逻辑回归分析。
纳入研究的36例患者中，每位患者ETS操作的中位数为13次（范围1 - 33次）。10.3%的操作出现氧饱和度下降，6.6%的操作出现严重低血压。在多因素分析中，去甲肾上腺素剂量、轻度镇静和吸痰前的氧饱和度下降与氧饱和度下降风险增加相关。去甲肾上腺素剂量、手动通气吸痰、吸痰联合患者重新定位以及在ICU治疗的第一天与严重低血压显著相关。
心脏骤停后患者在ICU治疗的第一天，ETS期间循环和呼吸恶化的风险增加，且与镇静、去甲肾上腺素剂量和操作前低氧血症有关。
