急诊科患者气管插管围术期不良事件及临床结局：BARCO研究
Peri-intubation adverse events and clinical outcomes in emergency department patients: the BARCO study.
作者信息
Maia Ian Ward A, Besen Bruno A M Pinheiro, Silva Lucas Oliveira J E, von Hellmann Rafael, Hajjar Ludhmila Abrahao, Sandefur Benjamin J, Pedrollo Daniel Fontana, Nogueira Caio Goncalves, Figueiredo Natalia Mansur P, Miranda Carlos Henrique, Martins Danilo, Baumgratz Thiago Dias, Bergesch Bruno, Costa Diogo, Colleoni Osmar, Zanettini Juliana, Freitas Ana Paula, Moreira Nicole Pinheiro, Gaspar Patricia Lopes, Tambelli Renato, Costa Maria Cristina, Silveira Samara, Correia Wilsterman, de Maria Rafael Garcia, Filho Ubirajara A Vinholes, Weber Andre P, da Silva Castro Vinicius, Dornelles Carlos Fernando D, Tabach Barbara S, Guimarães Hélio P, Stanzani Gabriela, Gava Thiago F, Mullan Aidan, Souza Heraldo P, Ranzani Otavio T, Bellolio Fernanda, Alencar Julio C G, da Cunha Victor Paro, Marchini Julio F, Moura Patricia Albuquerque, Greco Fernanda, Filippo Yasmine, Kai Rubens Yoshinori, Chimelli Guilherme Torres Abi Ramia, Valdivia Juan, Junior Edson Luiz Favero, Rischini Felipe, Câmara Vitor Amorim de Andrade, Bertotto Henrique, Borges Victor, Rathke Juliano, Melo Renato, Maiante Ariadine Augusta, Silva Sarah Maciel, de Oliveira Clarisse Moreira Ribeiro, Reis Andressa Pi Rocha, de Carvalho Rufato Thamyres, Dias Gabriella, Poloni Victoria Sartor, Lima Kauê, Zenly Hilana, Motta José Carlos, Miranda Gabriel, Freitas Alexandre, Gasperini Leonardo, Sudbrack Thais Raimondi, Ribeiro Ana Paula, do Carmo Guilherme Henrique A, de Vargas Tomelero Andrea, Konrath Augusto Lengler, Zanella Vitor Cremonese, Fuhr Natalia, Rosa Davi Amaral Cesário, Lima Isabela Lopes, Varela Luiz Fernando, Baldino Isabella, Zimmerman Andre, de Carvalho Julia M Dorn, Jeffrey Molly M
机构信息
Department of Emergency Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil.
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
出版信息
Crit Care. 2025 Apr 17;29(1):155. doi: 10.1186/s13054-025-05392-w.
BACKGROUND
Emergency tracheal intubation in critically ill patients carries a high risk of complications, and practices vary substantially across different settings. Identifying risk factors and understanding how peri-intubation adverse events affect patient outcomes may guide standardization of care and improve survival.
METHODS
This prospective cohort study involved 18 emergency departments in Brazil (March 2022-April 2024). We included adults (≥ 18 years) undergoing emergency intubation and excluded patients intubated electively or for cardiac arrest. We defined major peri-intubation adverse events as severe hypoxemia, new hemodynamic instability, or cardiac arrest occurring within 30 min of initiating intubation. The primary outcome was 28-day mortality. Multivariable regression analyses assessed associations between adverse events and mortality, controlling for potential confounders.
RESULTS
Among 2846 patients, major adverse events occurred in 919 (32.3%) intubations, most frequently new hemodynamic instability (20.0%), followed by severe hypoxemia (12.5%) and cardiac arrest (3.5%). The overall 28-day mortality was 45.1%. Patients experiencing any major adverse event had a significantly higher 28-day mortality (57.6 vs 39.2%; aHR 1.43, 95% CI 1.26-1.62; p < 0.001). Sensitivity analyses confirmed these findings. Successful first-attempt intubation was associated with a reduced likelihood of major adverse events (aOR 0.52; 95% CI 0.41-0.65; p < 0.001).
CONCLUSION
One in three patients undergoing emergency intubation experienced a major peri-intubation adverse event, which was associated with higher 28-day mortality. These results underscore the importance of optimizing intubation strategies to reduce complications and potentially improve patient outcomes in critically ill patients.
背景
重症患者的紧急气管插管并发症风险很高，不同环境下的操作差异很大。识别风险因素并了解插管围手术期不良事件如何影响患者预后，可能有助于护理标准化并提高生存率。
方法
这项前瞻性队列研究涉及巴西的18个急诊科（2022年3月至2024年4月）。我们纳入了接受紧急插管的成年人（≥18岁），排除了择期插管或因心脏骤停而插管的患者。我们将主要的插管围手术期不良事件定义为在开始插管后30分钟内发生的严重低氧血症、新的血流动力学不稳定或心脏骤停。主要结局是28天死亡率。多变量回归分析评估了不良事件与死亡率之间的关联，并对潜在混杂因素进行了控制。
结果
在2846例患者中，919例（32.3%）插管发生了主要不良事件，最常见的是新的血流动力学不稳定（20.0%），其次是严重低氧血症（12.5%）和心脏骤停（3.5%）。总体28天死亡率为45.1%。发生任何主要不良事件的患者28天死亡率显著更高（57.6%对39.2%；调整后风险比1.43，95%置信区间1.26-1.62；p<0.001）。敏感性分析证实了这些发现。首次插管成功与主要不良事件发生的可能性降低相关（调整后比值比0.52；95%置信区间0.41-0.65；p<0.001）。
结论
三分之一接受紧急插管的患者经历了主要的插管围手术期不良事件，这与更高的28天死亡率相关。这些结果强调了优化插管策略以减少并发症并潜在改善重症患者预后的重要性。
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