Mattson Alicia E, Brown Caitlin S, Sandefur Benjamin J, Cole Kristin, Haefke Brandon, Cabrera Daniel
Department of Pharmacy Services, Mayo Clinic Rochester, Rochester, MN, USA.
Department of Emergency Medicine, Mayo Clinic Rochester, Rochester, MN, USA.
Am J Health Syst Pharm. 2025 Jan 24;82(3):e148-e156. doi: 10.1093/ajhp/zxae217.
Rapid sequence intubation (RSI) is a common emergency department (ED) procedure with an associated complication of postintubation hypotension (PIH). It has not been clearly established whether the selection and dose of induction agent affect risk of PIH. The objective of this study was to determine the incidence of PIH in patients receiving full-dose compared to reduced-dose induction agent for RSI in the ED.
This was a health system-wide, retrospective cohort study comparing incidence of PIH based on the induction medication and dose given for RSI in the ED. Patients were included if they underwent RSI from July 1, 2018, through December 31, 2020, were 18 years of age or older, and received etomidate or ketamine. A reduced dose was defined as a ketamine dose of 1.25 mg/kg or less and an etomidate dose of 0.2 mg/kg or less.
A total of 909 patients were included in the final analysis, with most receiving etomidate (n = 764; 84%) and a smaller number receiving ketamine (n = 145; 16%). Patients who received ketamine had a higher mean pre-intubation shock index (full dose, 1.08; reduced dose, 1.04) than those who received etomidate (full dose, 0.89; reduced dose, 0.92) (P ≤ 0.001). Reduced doses of induction agent were observed for 107 patients receiving etomidate (14.0%) and 60 patients receiving ketamine (41.4%). Patients who received full-dose ketamine for induction had the highest rate of PIH (n = 31; 36.5%), and the difference was statistically significant compared to patients receiving reduced-dose ketamine (16.7%; P = 0.021) and full-dose etomidate (22.8%; P = 0.010).
We observed that full-dose ketamine was associated with the highest rate of PIH; however, this group had the poorest baseline hemodynamics, confounding interpretation. Our results do not support broad use of a reduced-dose induction agent.
快速顺序诱导插管（RSI）是急诊科常见的操作，存在插管后低血压（PIH）这一相关并发症。诱导药物的选择和剂量是否会影响PIH的风险尚未明确。本研究的目的是确定在急诊科接受全剂量与减少剂量诱导药物进行RSI的患者中PIH的发生率。
这是一项全卫生系统的回顾性队列研究，比较基于急诊科RSI诱导药物及剂量的PIH发生率。纳入2018年7月1日至2020年12月31日期间接受RSI、年龄18岁及以上且使用依托咪酯或氯胺酮的患者。减少剂量定义为氯胺酮剂量1.25mg/kg或更低以及依托咪酯剂量0.2mg/kg或更低。
最终分析共纳入909例患者，大多数使用依托咪酯（n = 764；84%），少数使用氯胺酮（n = 145；16%）。使用氯胺酮的患者插管前平均休克指数（全剂量，1.08；减少剂量，1.04）高于使用依托咪酯的患者（全剂量，0.89；减少剂量，0.92）（P≤0.001）。107例使用依托咪酯的患者（14.0%）和60例使用氯胺酮的患者（41.4%）观察到诱导药物剂量减少。接受全剂量氯胺酮诱导的患者PIH发生率最高（n = 31；36.5%），与接受减少剂量氯胺酮（16.7%；P = 0.021）和全剂量依托咪酯（22.8%；P = 0.010）的患者相比，差异具有统计学意义。
我们观察到全剂量氯胺酮与最高的PIH发生率相关；然而，该组基线血流动力学最差，混淆了结果解读。我们的结果不支持广泛使用减少剂量的诱导药物。
