Izvorni znanstveni članak
Rapid Sequence Intubation in the Pre-Hospital Setting – Difference Between Trauma and Nontrauma Patients
KATJA LAH
; Center for Emergency Medicine; Ljubljanska 5; 2000 Maribor; Slovenia
MILJENKO KRIZMARIC
; Faculty for Health Sciences; University of Maribor; Žitna ulica 15; 2000 Maribor, Slovenia
STEFEK GRMEC
; Medical Faculty University of Maribor; Slomškov trg 15; 2000 Maribor, Slovenia; Medical Faculty University of Ljubljana; Vrazov trg 2; 1104 Ljubljana, Slovenia
Sažetak
Aim. To determine, in a prospective observational study, whether there are differences in the practice of rapid sequence intubation (RSI) and to ascertain the characteristics between trauma and non-trauma patients that were intubated in a prehospital setting.
Methods. Included were patients (18 years and over) who were not in cardiac arrest and who underwent RSI and were transported to hospital. From January 2000 to December 2006 we intubated 636 patients in cardiac arrest, 159 critically ill non-trauma patients and 142 trauma patients. Placement of an endotracheal tube was confirmed by capnography. We compared medical and trauma groups of intubated patients. We used the two-independent sample t-test, Chi-square test and Wilcoxon-Mann Whitney test for statistical analysis.
Results. Statistical differences between groups (medical vs. trauma): initial main arterial pressure (104.9 +/- 34.6 vs. 90.7 +/- 24.8; p=0.01), blood glucose levels (9.2 +/- 3.5 vs. 5.9 +/- 1.9; p=0.011), administration of colloids (13,1 % vs. 70,2; p=0.003) and Hyperhaes (2.5 % vs.17.6 %; p=0.001), male gender (62.3 vs 81.6; p=0.014), rate of RSI (71.1 % vs. 96.4 %; p<0.001), initial GCS distribution 3-4/5-8/9-15 (30.9 % /61.6 % /7.5 % vs 11.7 % /60,2 % /28,1 %; p<0.001), initial pet CO2 (49,5 +/- 8,4 mmHg vs. 32,8 +/- 5.4 mmHg; p=0.007), APACHE II first day of hospitalization (25,9 +/- 4.9 vs. 20,8 +/- 3.6; p=0.002) and hospital mortality (78/159 (49.1 %) vs. 44/142 (30.1 %); p=0.023). We also analyzed the number of intubation attempts, intubation success rate, perceived difficulty of intubation and side effects with complications. The hospital survival analysis showed that survivors are younger (54.2 +/- 19.9 vs. 62.3 +/-18.8; p=0.019), have a higher rate of RSI (175/179(97.7 %) vs. 75/122(61.6 %); p=0.002) and have a better (lower) APACHE II score (19.9 +/-3.6 vs.28.3 +/- 4.6; p=0.002). We found the highest mortality rate in the subgroup of patients with non-traumatic intracranial hemorrhage (58.8 %, 60/102).
Conclusion. In non-trauma, critically ill patients we found a lower rate of RSI, more patients with an initial GCS of 3-4, higher APACHE II first day, higher initial pet CO2 and higher hospital mortality than in trauma patients.
Ključne riječi
rapid sequence intubation; pre-hospital setting; injured patients; critically ill patients; prognosis
Hrčak ID:
51532
URI
Datum izdavanja:
1.4.2010.
Posjeta: 1.453 *