Abstract：
BACKGROUND: There are no published minute-by-minute physiological assessment data for endotracheal intubation (ETT) performed in the intensive care unit (ICU). The majority of physiological data is available from Europe and North America where etomidate is the induction agent administered most commonly.
OBJECTIVE: The aim of this study was to describe the feasibility of obtaining minute-by-minute physiological and medication data surrounding ETT in an Australian tertiary ICU and to assess its associated outcomes.
METHODS: We performed a single-centre feasibility observational study. We obtained minute-by-minute data on physiological variables and medications for 15 min before and 30 min after ETT. We assessed feasibility as enrolled to screened patient ratio and completeness of data collection in enrolled patients. Severe hypotension (systolic blood pressure < 65 mmHg) and severe hypoxaemia (pulse oximetry saturation < 80%) were the secondary clinical outcomes.
RESULTS: We screened 43 patients and studied 30 patients. The median age was 58.5 (interquartile range: 49-70) years, and 18 (60%) were male. Near-complete (97%) physiological and medication data were obtained in all patients at all times. Overall, 15 (50%) ETTs occurred after hours (17:30-08:00) and 90% were by video laryngoscopy with a 90% first-pass success rate. Prophylactic vasopressors were used in 50% of ETTs. Fentanyl was used in all except one ETT at a median dose of 2.5 mcg/kg. Propofol (63%) or midazolam (50%) were used as adjuncts at low dose. Rocuronium was used in all but one patient. There were no episodes of severe hypotension and only one episode of short-lived severe hypoxaemia.
CONCLUSIONS: Minute-by-minute recording of ETT-associated physiological changes in the ICU was feasible but only fully available in two-thirds of the screened patients. ETT was based on fentanyl induction, low-dose adjunctive sedation, and frequent prophylactic vasopressor therapy and was associated with no severe hypotension and a single short-lived episode of severe hypoxaemia.
OBJECTIVE: The aim of this study was to describe the feasibility of obtaining minute-by-minute physiological and medication data surrounding ETT in an Australian tertiary ICU and to assess its associated outcomes.
METHODS: We performed a single-centre feasibility observational study. We obtained minute-by-minute data on physiological variables and medications for 15 min before and 30 min after ETT. We assessed feasibility as enrolled to screened patient ratio and completeness of data collection in enrolled patients. Severe hypotension (systolic blood pressure < 65 mmHg) and severe hypoxaemia (pulse oximetry saturation < 80%) were the secondary clinical outcomes.
RESULTS: We screened 43 patients and studied 30 patients. The median age was 58.5 (interquartile range: 49-70) years, and 18 (60%) were male. Near-complete (97%) physiological and medication data were obtained in all patients at all times. Overall, 15 (50%) ETTs occurred after hours (17:30-08:00) and 90% were by video laryngoscopy with a 90% first-pass success rate. Prophylactic vasopressors were used in 50% of ETTs. Fentanyl was used in all except one ETT at a median dose of 2.5 mcg/kg. Propofol (63%) or midazolam (50%) were used as adjuncts at low dose. Rocuronium was used in all but one patient. There were no episodes of severe hypotension and only one episode of short-lived severe hypoxaemia.
CONCLUSIONS: Minute-by-minute recording of ETT-associated physiological changes in the ICU was feasible but only fully available in two-thirds of the screened patients. ETT was based on fentanyl induction, low-dose adjunctive sedation, and frequent prophylactic vasopressor therapy and was associated with no severe hypotension and a single short-lived episode of severe hypoxaemia.
摘要：
背景：在重症监护病房（ICU）中进行的气管插管（ETT）没有公开的每分钟生理评估数据。大多数生理数据可从欧洲和北美获得，其中依托咪酯是最常用的诱导剂。
目的：本研究的目的是描述在澳大利亚三级ICU中获取ETT周围的每分钟生理和药物数据的可行性，并评估其相关结果。
方法：我们进行了单中心可行性观察性研究。我们获得了ETT之前15分钟和之后30分钟的生理变量和药物的每分钟数据。我们评估了入选与筛选患者比例的可行性以及入选患者数据收集的完整性。严重低血压（收缩压<65mmHg）和严重低氧血症（脉搏血氧饱和度<80％）是次要临床结果。
结果：我们筛选了43名患者，研究了30名患者。中位年龄为58.5岁（四分位距：49-70岁），18（60％）为男性。几乎完整（97％）的生理和药物数据在所有时间获得所有患者。总的来说,15例（50％）ETT在数小时（17：30-08：00）后发生，90％通过视频喉镜检查，首过成功率为90％。在50％的ETT中使用了预防性血管加压药。除一种ETT外，所有ETT均使用芬太尼，中位剂量为2.5mcg/kg。丙泊酚（63％）或咪达唑仑（50％）在低剂量下用作助剂。除一名患者外，所有患者都使用了罗库溴铵。没有严重低血压发作，只有一次短暂的严重低氧血症发作。
结论：每分钟记录ICU中与ETT相关的生理变化是可行的，但仅在三分之二的筛查患者中完全可用。ETT是基于芬太尼诱导，低剂量辅助镇静,和频繁的预防性血管加压药治疗，并没有严重低血压和单一的短期严重低氧血症发作。
目的：本研究的目的是描述在澳大利亚三级ICU中获取ETT周围的每分钟生理和药物数据的可行性，并评估其相关结果。
方法：我们进行了单中心可行性观察性研究。我们获得了ETT之前15分钟和之后30分钟的生理变量和药物的每分钟数据。我们评估了入选与筛选患者比例的可行性以及入选患者数据收集的完整性。严重低血压（收缩压<65mmHg）和严重低氧血症（脉搏血氧饱和度<80％）是次要临床结果。
结果：我们筛选了43名患者，研究了30名患者。中位年龄为58.5岁（四分位距：49-70岁），18（60％）为男性。几乎完整（97％）的生理和药物数据在所有时间获得所有患者。总的来说,15例（50％）ETT在数小时（17：30-08：00）后发生，90％通过视频喉镜检查，首过成功率为90％。在50％的ETT中使用了预防性血管加压药。除一种ETT外，所有ETT均使用芬太尼，中位剂量为2.5mcg/kg。丙泊酚（63％）或咪达唑仑（50％）在低剂量下用作助剂。除一名患者外，所有患者都使用了罗库溴铵。没有严重低血压发作，只有一次短暂的严重低氧血症发作。
结论：每分钟记录ICU中与ETT相关的生理变化是可行的，但仅在三分之二的筛查患者中完全可用。ETT是基于芬太尼诱导，低剂量辅助镇静,和频繁的预防性血管加压药治疗，并没有严重低血压和单一的短期严重低氧血症发作。
