Urgent intubation without neuromuscular blocking agents and the risk of tracheostomy
| Autor: | Mutsuo Onodera, Jun Fujinaga, Akira Kuriyama, Hiroyuki Doi, Etsuji Suzuki |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Airway management 030204 cardiovascular system & hematology EM - Original Risk Assessment law.invention 03 medical and health sciences 0302 clinical medicine Tracheostomy Japan law Risk Factors Internal Medicine medicine Intubation Intratracheal Intubation Humans 030212 general & internal medicine Retrospective Studies business.industry Emergency patients Tracheal intubation Retrospective cohort study Odds ratio Emergency department Length of Stay Middle Aged Neuromuscular Blocking Agents Intensive care unit Confidence interval Neuromuscular blocking agents Emergency medicine Emergency Medicine Female business |
| Zdroj: | Internal and Emergency Medicine |
| ISSN: | 1970-9366 1828-0447 |
| Popis: | Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan. We included patients who underwent urgent tracheal intubation at the emergency department or the ICU and were admitted to the ICU between April 2013 and November 2017. We extracted data on methods and medications of intubation, predictors for difficult intubation, Cormack–Lehane grade, patient demographics, primary diagnoses, reintubation. We estimated odds ratios and their 95% confidence intervals for elective tracheostomy during the ICU stay using logistic regression models. Of 411 patients, 46 patients underwent intubation without neuromuscular blocking agents and 61 patients underwent tracheostomy. After adjusting for potential confounders, patients who avoided neuromuscular blocking agents had more than double the odds of tracheostomy (odds ratio 2.59, 95% confidence interval 1.06–6.34, p value = 0.04). When stratifying the subjects by risk status for tracheostomy, the association was more pronounced in high-risk group, while we observed less significant association in the low-risk group. Avoidance of neuromuscular blocking agents for urgent intubation increases the risk of tracheostomy among emergency patients, especially those who have a higher risk for tracheostomy. Electronic supplementary material The online version of this article (10.1007/s11739-019-02214-0) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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