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危重成人患者气管插管期间的球囊面罩通气
Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults


Jonathan D. Casey ... 其他 • 2019.02.28
相关阅读
• ICU插管期间使用球囊面罩通气可能有益 • 持续气道正压通气是否能降低心血管疾病的风险?

摘要


背景

低氧血症是危重成人患者气管插管期间最常见的并发症,可能会增加心脏停搏和死亡的风险。在重症成人患者气管插管期间使用球囊面罩装置进行正压通气(球囊面罩通气)能否预防低氧血症而不增加误吸风险仍然存在争议。

 

方法

我们在美国7个重症监护治疗病房开展了多中心随机试验,将接受气管插管的成人患者随机分组,分别在诱导和喉镜检查的间期使用球囊面罩装置进行通气,或不进行通气。主要结局是从诱导至气管插管后2分钟期间观察到的最低氧饱和度。次要结局是重度低氧血症(定义为氧饱和度低于80%)发生率。

 

结果

在纳入试验的401例患者中,球囊面罩通气组和非通气组的中位最低氧饱和度分别为96%(四分位距,87%~99%)和93%(四分位距,81%~99%)(P=0.01)。球囊面罩通气组21例患者(10.9%)和非通气组45例患者(22.8%)发生了重度低氧血症(相对危险度,0.48;95%置信区间[CI],0.30~0.77)。球囊面罩通气组2.5%的插管期间和非通气组4.0%的插管期间发生了操作者报告的误吸(P=0.41)。在气管插管后48小时内,胸片上新阴影的发生率分别为16.4%和14.8%(P=0.73)

 

结论

在接受气管插管的危重成人患者中,与未接受通气的患者相比,接受球囊面罩通气患者的氧饱和度较高,重度低氧血症发生率较低(由范德比尔特临床和转化研究所[Vanderbilt Institute for Clinical and Translational Research]等资助;PreVent在ClinicalTrials.gov注册号为NCT03026322)。





作者信息

Jonathan D. Casey, M.D., David R. Janz, M.D., Derek W. Russell, M.D., Derek J. Vonderhaar, M.D., Aaron M. Joffe, D.O., Kevin M. Dischert, M.D., Ryan M. Brown, M.D., Aline N. Zouk, M.D., Swati Gulati, M.B., B.S., Brent E. Heideman, M.D., Michael G. Lester, M.D., Alexandra H. Toporek, M.D., Itay Bentov, M.D., Ph.D., Wesley H. Self, M.D., Todd W. Rice, M.D., and Matthew W. Semler, M.D. for the PreVent Investigators and the Pragmatic Critical Care Research Group*
From the Division of Allergy, Pulmonary, and Critical Care Medicine (J.D.C., R.M.B., B.E.H., M.G.L., A.H.T., T.W.R., M.W.S.), and the Department of Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; the Section of Pulmonary, Critical Care, and Allergy and Immunology (D.R.J.), and the Section of Emergency Medicine (D.J.V.), Louisiana State University School of Medicine–New Orleans, and the Department of Pulmonary and Critical Care Medicine, Ochsner Health System (D.J.V., K.M.D.) — both in New Orleans; the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham (D.W.R., A.N.Z., S.G.); and the Department of Anesthesiology and Pain Medicine (A.M.J.) and the Division of Pulmonary and Critical Care (I.B.), University of Washington School of Medicine, Seattle. Address reprint requests to Dr. Casey at the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1210 MCN, 1161 21st Ave. S., Nashville, TN 37232-2650, or at jonathan.d.casey@vumc.org. *A full list of the PreVent investigators is provided in the Supplementary Appendix, available at NEJM.org.

 

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