Association between off-hour presentation and endotracheal-intubation-related adverse events in trauma patients with a predicted difficult airway: A historical cohort study at a community emergency department in Japan

被引：14

作者：

Ono, Yuko ^{[1
,2
]}

Sugiyama, Takuya ^{[1
]}

Chida, Yasuyuki ^{[1
]}

Sato, Tetsuya ^{[1
]}

Kikuchi, Hiroaki ^{[1
]}

Suzuki, Daiji ^{[3
]}

Ikeda, Masakazu ^{[4
]}

Tanigawa, Koichi ^{[5
,6
]}

Shinohara, Kazuaki ^{[1
]}

机构：

[1] Ohta Nishinouchi Hosp, Ohta Gen Hosp Fdn, Dept Anesthesiol, 2-5-20 Nishinouchi, Koriyama, Fukushima 9638558, Japan

[2] Fukushima Med Univ Hosp, Emergency & Crit Care Med Ctr, 1 Hikarigaoka, Fukushima 9601295, Japan

[3] Ohta Nishinouchi Hosp, Ohta Gen Hosp Fdn, Dept Head & Neck Surg, 2-5-20 Nishinouchi, Koriyama, Fukushima 9638558, Japan

[4] Fukushima Med Univ, Dept Otolaryngol, 1 Hikarigaoka, Fukushima 9601295, Japan

[5] Fukushima Med Univ, 1 Hikarigaoka, Fukushima 9601295, Japan

[6] Fukushima Global Med Sci Ctr, 1 Hikarigaoka, Fukushima 9601295, Japan

来源：

SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE | 2016年 / 24卷

关键词：

Airway management; Comminuted facial trauma; Difficult airway management; Fatal complication; Inhalational burn; Penetrating neck injury; INTENSIVE-CARE-UNIT; INJURY SEVERITY SCORE; TRACHEAL INTUBATION; MULTIPLE-CENTER; COMPLICATIONS; MANAGEMENT; MEDICINE; WEEKENDS; MORTALITY; RISK;

D O I：

10.1186/s13049-016-0296-2

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population. The aim of this study was to determine whether off-hour presentation was associated with ETI complications in injured patients with a predicted difficult airway. Methods: This historical cohort study was conducted at a Japanese community emergency department (ED). All patients with inhalation burn, comminuted facial trauma (Abbreviated Injury Scale Score Face >= 3), and penetrating neck injury who underwent ETI from January 2007 to January 2016 in our ED were included. Primary exposure was off-hour presentation, defined as the period from 6: 01 PM to 8: 00 AM weekdays plus the entire weekend. The primary outcome measure was the occurrence of an ETI-related adverse event, including hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, cuff leak, and mainstem bronchus intubation. Results: Of the 123 patients, 75 (61.0 %) were intubated during off hours. Crude analysis showed that off-hour presentation was significantly associated with an increased risk of ETI-related adverse events [odds ratio (OR), 2.5; 95 % confidence interval (CI), 1.1-5.6; p = 0.033]. The increased risk remained significant after adjusting for potential confounders, including operator being an anesthesiologist, use of a paralytic agent, and injury severity score (OR, 3.0; 95 % CI, 1.1-8.4; p = 0.034). Conclusions: In this study, off-hour presentation was independently associated with ETI-related adverse events in trauma patients with a predicted difficult airway. These data imply the need for more attentive hospital care during nights and weekends.

引用

页数：10

共 47 条

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