紧急插管时预氧合的无创通气。
Noninvasive Ventilation for Preoxygenation during Emergency Intubation.
机构信息
From the Department of Medicine, Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases (K.W.G., J.A.P.), the Department of Anesthesiology, Section of Critical Care Medicine (J.P.G., J.K.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Wake Forest School of Medicine, Winston-Salem, NC; the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine (M.W.S., K.P.S., A. Muhs, T.W.R., J.R., K.W., J.D.C.), the Departments of Emergency Medicine (W.H.S., B.D.L.) and Biostatistics (B.I.), and Vanderbilt Institute for Clinical and Translational Research (W.H.S., B.D.L.), Vanderbilt University Medical Center, Nashville; the Department of Emergency Medicine (B.E.D., M.E.P., S.J. Hansen) and the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J. Hansen), Hennepin County Medical Center, Minneapolis; the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington (S.B.S., J.M.W.), and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.) - both in Massachusetts; the Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University, Columbus (C.T., P.J.K.); the Department of Emergency Medicine (D.R.-A., S.G.S., C.W., S.A.T., V.S.B., A.A.G.) and the Center for COMBAT Research (V.S.B.), University of Colorado School of Medicine, and the Department of Medicine, Division of Pulmonary Sciences and Critical Care (N.R.A., P.D.S.), and the Department of Anesthesiology (J.C.B., S.G.S., N.K.), University of Colorado Anschutz Medical Campus - both in Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Baylor Scott and White Medical Center, Temple (H.D.W., S.A.G.), and U.S. Army Institute of Surgical Research (S.G.S., B.J.L.) and Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston (S.G.S., B.J.L.), and the 59th Medical Wing, Joint Base San Antonio-Lackland (B.J.L.), San Antonio - all in Texas; the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (S.G., M.R.W., D.W.R., D.B.P.), and the Departments of Emergency Medicine (M.R.W.) and Anesthesiology and Perioperative Medicine (A.B.B.), Heersink School of Medicine, University of Alabama at Birmingham, and Birmingham Veterans Affairs Medical Center, Pulmonary Section (D.W.R.) - both in Birmingham; the Department of Internal Medicine, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City (K.C.D., A.S.); the Department of Critical Care Medicine (A. Mohamed, L.A., V.B., A. Moskowitz, R.M.) and the Department of Medicine, Pulmonary Division (D.G.F.), Montefiore Einstein, Bronx, NY; the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland (A.K., G.A.); Our Lady of the Lake Regional Medical Center, Emergency Medicine Residency Program-Baton Rouge Campus (L.H.B., S.M.A.), and the Department of Pulmonary and Critical Care Medicine, Internal Medicine Residency Program-Baton Rouge Campus (J.E.W., C.B.T.), Louisiana State University Health Sciences Center School of Medicine-New Orleans, Baton Rouge; the Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine (S.J. Halliday, M.T.L.), and the Department of Anesthesia (M.T.L.), University of Wisconsin-Madison School of Medicine and Public Health, Madison; the Department of Emergency Medicine, Denver Health Medical Center, Denver (S.A.T.); and the University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine, New Orleans (D.R.J.).
出版信息
N Engl J Med. 2024 Jun 20;390(23):2165-2177. doi: 10.1056/NEJMoa2313680. Epub 2024 Jun 13.
BACKGROUND
Among critically ill adults undergoing tracheal intubation, hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain.
METHODS
In a multicenter, randomized trial conducted at 24 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults (age, ≥18 years) undergoing tracheal intubation to receive preoxygenation with either noninvasive ventilation or an oxygen mask. The primary outcome was hypoxemia during intubation, defined by an oxygen saturation of less than 85% during the interval between induction of anesthesia and 2 minutes after tracheal intubation.
RESULTS
Among the 1301 patients enrolled, hypoxemia occurred in 57 of 624 patients (9.1%) in the noninvasive-ventilation group and in 118 of 637 patients (18.5%) in the oxygen-mask group (difference, -9.4 percentage points; 95% confidence interval [CI], -13.2 to -5.6; P<0.001). Cardiac arrest occurred in 1 patient (0.2%) in the noninvasive-ventilation group and in 7 patients (1.1%) in the oxygen-mask group (difference, -0.9 percentage points; 95% CI, -1.8 to -0.1). Aspiration occurred in 6 patients (0.9%) in the noninvasive-ventilation group and in 9 patients (1.4%) in the oxygen-mask group (difference, -0.4 percentage points; 95% CI, -1.6 to 0.7).
CONCLUSIONS
Among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation resulted in a lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask. (Funded by the U.S. Department of Defense; PREOXI ClinicalTrials.gov number, NCT05267652.).
背景
在接受气管插管的危重症成人中，低氧血症会增加心脏骤停和死亡的风险。与使用氧气面罩预充氧相比，使用无创通气进行预充氧对气管插管期间低氧血症的发生率的影响尚不确定。
方法
在美国 24 个急诊室和重症监护病房进行的一项多中心、随机试验中，我们将接受气管插管的危重症成人（年龄≥18 岁）随机分配至接受无创通气或氧气面罩预充氧。主要结局是插管期间的低氧血症，定义为麻醉诱导期间至气管插管后 2 分钟之间的氧饱和度低于 85%。
结果
在纳入的 1301 例患者中，无创通气组 624 例患者中有 57 例（9.1%）发生低氧血症，氧气面罩组 637 例患者中有 118 例（18.5%）发生低氧血症（差值为-9.4 个百分点；95%置信区间为-13.2 至-5.6；P<0.001）。无创通气组发生 1 例（0.2%）心脏骤停，氧气面罩组发生 7 例（1.1%）（差值为-0.9 个百分点；95%置信区间为-1.8 至-0.1）。无创通气组有 6 例（0.9%）发生误吸，氧气面罩组有 9 例（1.4%）（差值为-0.4 个百分点；95%置信区间为-1.6 至 0.7）。
结论
在接受气管插管的危重症成人中，与使用氧气面罩预充氧相比，使用无创通气进行预充氧可降低插管期间低氧血症的发生率。（由美国国防部资助；PREOXI ClinicalTrials.gov 编号，NCT05267652。）
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