Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2021 Dec;44(6 Suppl 1):S110-S118. doi: 10.1016/j.bj.2020.07.006. Epub 2020 Jul 27.
Emergency endotracheal intubations outside the operating room (OR) are associated with high complications. We compare the outcome of emergency endotracheal intubation in the general ward, the intensive care unit (ICU) and the emergency department (ED).
We retrospectively analyzed adult patients requiring emergency endotracheal intubation that called for anesthesiologists at our tertiary care institution from January 1, 2015 to December 31, 2016. We evaluated the outcomes, including aspiration, hemodynamic collapse, pneumothorax, emergency tracheostomy, and survival to hospital discharge in the general ward, ICU, and ED.
There were 416 non-OR emergency endotracheal intubation calls for the anesthesiologist. Among these areas, the ED had the highest proportion of difficult endotracheal (DET) intubation (n = 144 [80.4%]), followed by the general ward (n = 85 [66.4%]), and then the ICU (n = 65 [59.6%]). The incidence of hemodynamic collapse was higher in the general ward (n = 44 [34.4%]) than the ICU (n = 18 [16.5%]) or the ED (n = 16 [9.0%]). We reported the survival rate of the general ward (55.5%), which was lower than the ICU (63.3%) and the ED (80.4%). Among these locations, the ED had the highest rate of neurologically intact (91%) to hospital discharge, compared to the ICU (56.6%) and the general ward (55%). As for the ED, although there was no difference in survival between non-preventive and preventive intubations, preventive intubations was associated with high neurological intact with hospital discharge.
Emergency and DET intubation in the general ward and ICU resulted in a higher incidence of hemodynamic collapse and mortality than those performed in the ED. Early calls for the anesthesiologist for DET intubation without medications in the ED resulted in a higher rate of neurologically intact survival to hospital discharge.
在手术室（OR）外进行紧急气管插管与较高的并发症相关。我们比较了普通病房、重症监护病房（ICU）和急诊部（ED）进行紧急气管插管的结果。
我们回顾性分析了 2015 年 1 月 1 日至 2016 年 12 月 31 日期间，我们的三级医疗机构要求麻醉师进行紧急气管插管的成年患者。我们评估了普通病房、ICU 和 ED 的结局，包括吸入、血流动力学崩溃、气胸、紧急气管切开术和存活至出院。
有 416 例非 OR 紧急气管插管呼叫麻醉师。在这些区域中，ED 的困难气管插管（DET）比例最高（n=144[80.4%]），其次是普通病房（n=85[66.4%]），然后是 ICU（n=65[59.6%]）。普通病房（n=44[34.4%]）血流动力学崩溃的发生率高于 ICU（n=18[16.5%]）或 ED（n=16[9.0%]）。我们报告了普通病房（55.5%）的存活率，低于 ICU（63.3%）和 ED（80.4%）。在这些位置中，ED 的出院时神经功能完整（91%）的比例最高，其次是 ICU（56.6%）和普通病房（55%）。对于 ED，虽然非预防性和预防性插管的存活率没有差异，但预防性插管与神经功能完整出院相关。
普通病房和 ICU 的紧急和 DET 插管导致血流动力学崩溃和死亡率高于 ED。ED 早期呼叫麻醉师进行无药物 DET 插管，可提高神经功能完整的存活率至出院。
