PDF(Pubmed)
Abstract：
Ketamine and etomidate are commonly used as sedatives in rapid sequence intubation (RSI). However, there is no consensus on which agent should be favored when treating patients with trauma. This study aimed to compare the effects of ketamine and etomidate on first-pass success and outcomes of patients with trauma after RSI-facilitated emergency intubation.
We retrospectively reviewed 944 patients who underwent endotracheal intubation in a trauma bay at a Korean level 1 trauma center between January 2019 and December 2021. Outcomes were compared between the ketamine and etomidate groups after propensity score matching to balance the overall distribution between the two groups.
In total, 620 patients were included in the analysis, of which 118 (19.9%) were administered ketamine and the remaining 502 (80.1%) were treated with etomidate. Patients in the ketamine group showed a significantly faster initial heart rate (105.0 ± 25.7 vs. 97.7 ± 23.6, p = 0.003), were more hypotensive (114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg, p < 0.001), and had higher Glasgow Coma Scale (9.1 ± 4.0 vs. 8.2 ± 4.0, p = 0.031) and Injury Severity Score (32.5 ± 16.3 vs. 27.0 ± 13.3, p < 0.001) than those in the etomidate group. There were no significant differences in the first-pass success rate (90.7% vs. 90.1%, p > 0.999), final mortality (16.1% vs. 20.6, p = 0.348), length of stay in the intensive care unit (days) (8 [4, 15] (Interquartile range)), vs. 10 [4, 21], p = 0.998), ventilator days (4 [2, 10] vs. 5 [2, 13], p = 0.735), and hospital stay (days) (24.5 [10.25, 38.5] vs. 22 [8, 40], p = 0.322) in the 1:3 propensity score matching analysis.
In this retrospective study of trauma resuscitation, those receiving intubation with ketamine had greater hemodynamic instability than those receiving etomidate. However, there was no significant difference in clinical outcomes between patients sedated with ketamine and those treated with etomidate.
We retrospectively reviewed 944 patients who underwent endotracheal intubation in a trauma bay at a Korean level 1 trauma center between January 2019 and December 2021. Outcomes were compared between the ketamine and etomidate groups after propensity score matching to balance the overall distribution between the two groups.
In total, 620 patients were included in the analysis, of which 118 (19.9%) were administered ketamine and the remaining 502 (80.1%) were treated with etomidate. Patients in the ketamine group showed a significantly faster initial heart rate (105.0 ± 25.7 vs. 97.7 ± 23.6, p = 0.003), were more hypotensive (114.2 ± 32.8 mmHg vs. 139.3 ± 34.4 mmHg, p < 0.001), and had higher Glasgow Coma Scale (9.1 ± 4.0 vs. 8.2 ± 4.0, p = 0.031) and Injury Severity Score (32.5 ± 16.3 vs. 27.0 ± 13.3, p < 0.001) than those in the etomidate group. There were no significant differences in the first-pass success rate (90.7% vs. 90.1%, p > 0.999), final mortality (16.1% vs. 20.6, p = 0.348), length of stay in the intensive care unit (days) (8 [4, 15] (Interquartile range)), vs. 10 [4, 21], p = 0.998), ventilator days (4 [2, 10] vs. 5 [2, 13], p = 0.735), and hospital stay (days) (24.5 [10.25, 38.5] vs. 22 [8, 40], p = 0.322) in the 1:3 propensity score matching analysis.
In this retrospective study of trauma resuscitation, those receiving intubation with ketamine had greater hemodynamic instability than those receiving etomidate. However, there was no significant difference in clinical outcomes between patients sedated with ketamine and those treated with etomidate.
摘要：
背景：氯胺酮和依托咪酯通常用作快速顺序插管（RSI）的镇静剂。然而,对于在治疗创伤患者时应该选择哪种药物,目前尚无共识.这项研究旨在比较氯胺酮和依托咪酯对RSI促进的急诊插管后创伤患者的首过成功率和预后的影响。
方法：我们回顾性分析了在2019年1月至2021年12月期间在韩国一级创伤中心的创伤舱内接受气管插管的944例患者。在倾向评分匹配以平衡两组之间的总体分布后，比较氯胺酮和依托咪酯组之间的结果。
结果：总计，620名患者被纳入分析，其中118（19.9％）给予氯胺酮，其余502（80.1％）给予依托咪酯。氯胺酮组患者的初始心率明显加快（105.0±25.7vs.97.7±23.6，p=0.003），更低血压(114.2±32.8mmHg与139.3±34.4mmHg，p<0.001)，格拉斯哥昏迷评分较高（9.1±4.0vs.8.2±4.0，p=0.031）和伤害严重程度评分（32.5±16.3vs.27.0±13.3，p<0.001）比依托咪酯组。首过成功率没有显着差异（90.7%与90.1%,p>0.999),最终死亡率（16.1%vs.20.6，p=0.348），在重症监护病房的住院时间（天）（8[4，15]（四分位距）），vs.10[4,21],p=0.998),呼吸机天数(4[2,10]vs.5[2,13],p=0.735),和住院天数（天）（24.5[10.25，38.5]vs.22[8,40],p=0.322)在1:3倾向得分匹配分析中。
结论：在这项创伤复苏的回顾性研究中，接受氯胺酮插管的患者比接受依托咪酯的患者有更大的血流动力学不稳定性.然而,氯胺酮镇静患者和依托咪酯治疗患者的临床结局无显著差异.
方法：我们回顾性分析了在2019年1月至2021年12月期间在韩国一级创伤中心的创伤舱内接受气管插管的944例患者。在倾向评分匹配以平衡两组之间的总体分布后，比较氯胺酮和依托咪酯组之间的结果。
结果：总计，620名患者被纳入分析，其中118（19.9％）给予氯胺酮，其余502（80.1％）给予依托咪酯。氯胺酮组患者的初始心率明显加快（105.0±25.7vs.97.7±23.6，p=0.003），更低血压(114.2±32.8mmHg与139.3±34.4mmHg，p<0.001)，格拉斯哥昏迷评分较高（9.1±4.0vs.8.2±4.0，p=0.031）和伤害严重程度评分（32.5±16.3vs.27.0±13.3，p<0.001）比依托咪酯组。首过成功率没有显着差异（90.7%与90.1%,p>0.999),最终死亡率（16.1%vs.20.6，p=0.348），在重症监护病房的住院时间（天）（8[4，15]（四分位距）），vs.10[4,21],p=0.998),呼吸机天数(4[2,10]vs.5[2,13],p=0.735),和住院天数（天）（24.5[10.25，38.5]vs.22[8,40],p=0.322)在1:3倾向得分匹配分析中。
结论：在这项创伤复苏的回顾性研究中，接受氯胺酮插管的患者比接受依托咪酯的患者有更大的血流动力学不稳定性.然而,氯胺酮镇静患者和依托咪酯治疗患者的临床结局无显著差异.
