Emergency Department of Şişli Hamidiye Etfal Training and Research Hospital Huzur Mh, Cumhuriyet, Sarıyer, İstanbul, 34396, Turkey.
Emergency Department of Prof.Dr. Süleyman Yalçın Hospital, Istanbul, Turkey.
BMC Emerg Med. 2024 Oct 11;24(1):187. doi: 10.1186/s12873-024-01100-z.
In patients presenting to the emergency department (ED) with acute respiratory failure, non-invasive mechanical ventilation (NIMV) is applied when conventional oxygen support is not sufficient. Patients who are agitated often have very low NIMV compliance and a transition to invasive mechanical ventilation (IMV) is often required. To avoid IMV, a suitable sedative agent can be utilized. The aim of this research is to investigate the relationship between ketamine administration to patients who are non-compliant with NIMV due to agitation and the outcome of their intubation.
This retrospective study included patients with acute respiratory failure who were admitted to the ED from 2021 to 2022 and used Richmond Agitation Sedation Scale (RASS) to identify agitation level of patients. The relationship between ketamine administration in this patient group and NIMV compliance and intubation rate was evaluated.
A total of 81 patients, including 35 (43.2%) men and 46 (56.8%) women, were included in the study. Of these patients, 46 (56.8%) were intubated despite ketamine administration, while 35 (43.2%) were compliant with NIMV and were not intubated. When evaluating the RASS, which shows the agitation levels of the patients, the non-intubated group was found to be 2.17 ± 0.68, while the intubated group was 2.66 ± 0.73, and it was statistically significant that the NIMV intubated group was higher (p = 0.003).
This study showed that agitation can impair NIMV compliance in patients with acute respiratory failure. However, a significant proportion of this patient group can be avoided through IMV with proper sedative agents.
在因呼吸急促而到急诊科就诊的患者中，如果常规氧疗支持不足，会应用无创机械通气（NIMV）。常因烦躁而不配合 NIMV 的患者往往配合度非常低，通常需要过渡到有创机械通气（IMV）。为了避免 IMV，可以使用合适的镇静剂。本研究旨在探讨因烦躁而不配合 NIMV 的患者使用氯胺酮与气管插管结果之间的关系。
本回顾性研究纳入了 2021 年至 2022 年因急性呼吸衰竭而入住急诊科的患者，并使用 Richmond 躁动镇静量表（RASS）来确定患者的躁动程度。评估该患者组中氯胺酮给药与 NIMV 依从性和插管率之间的关系。
共纳入 81 例患者，其中男 35 例（43.2%），女 46 例（56.8%）。这些患者中，46 例（56.8%）尽管给予了氯胺酮仍行气管插管，35 例（43.2%）对 NIMV 依从且未行气管插管。在评估 RASS 以显示患者的躁动程度时，发现未插管组为 2.17±0.68，而插管组为 2.66±0.73，插管组明显更高（p=0.003）。
本研究表明，躁动会降低急性呼吸衰竭患者对 NIMV 的依从性。然而，通过适当的镇静剂，很大一部分此类患者可以避免行 IMV。
