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首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >Apneic Oxygenation As a Quality Improvement Intervention in an Academic PICU*
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Apneic Oxygenation As a Quality Improvement Intervention in an Academic PICU*

机译：牛桂氧合作为学术PICU *的质量改进干预

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Objectives: To evaluate if the use of apneic oxygenation during tracheal intubation in children is feasible and would decrease the occurrence of oxygen desaturation. Design: Prospective pre/post observational study. Setting: A large single-center noncardiac PICU in North America. Patients: All patients less than 18 years old who underwent primary tracheal intubation from August 1, 2014, to September 30, 2018. Interventions: Implementation of apneic oxygenation for all primary tracheal intubation as quality improvement. Measurements and Main Results: Total of 1,373 tracheal intubations (661 preimplementation and 712 postimplementation) took place during study period. Within 2 months, apneic oxygenation use reached to predefined adherence threshold (> 80% of primary tracheal intubations) after implementation and sustained at greater than 70% level throughout the postimplementation. Between the preimplementation and postimplementation, no significant differences were observed in patient demographics, difficult airway features, or providers. Respiratory and procedural indications were more common during preintervention. Video laryngoscopy devices were used more often during the postimplementation (pre 5% vs post 75%; p < 0.001). Moderate oxygen desaturation less than 80% were observed in fewer tracheal intubations after apneic oxygenation implementation (pre 15.4% vs post 11.8%; p = 0.049); severe oxygen desaturation less than 70% was also observed in fewer tracheal intubations after implementation (pre 10.4% vs post 7.2%; p = 0.032). Hemodynamic tracheal intubation associated events (i.e., cardiac arrests, hypotension, dysrhythmia) were unchanged (pre 3.2% vs post 2.0%; p = 0.155). Multivariable analyses showed apneic oxygenation implementation was significantly associated with a decrease in moderate desaturation less than 80% (adjusted odds ratio, 0.55; 95% CI, 0.34-0.88) and with severe desaturation less than 70% (adjusted odds ratio, 0.54; 95% CI, 0.31-0.96) while adjusting for tracheal intubation indications and device. Conclusions: Implementation of apneic oxygenation in PICU was feasible, and was associated with significant reduction in moderate and severe oxygen desaturation. Use of apneic oxygenation should be considered when intubating critically ill children.
机译：目标：评估儿童气管插管期间的牛桂化是否可行，并且会降低氧气去饱和的发生。设计：潜在预/后观察到研究。环境：北美的一个大型单中心非心律picu。患者：少于18岁的患者从2014年8月1日至2018年8月1日接受了原发性气管插管。干预：对所有原发性气管插管的促​​进氧气的实施作为质量改善。测量和主要结果：在研究期间进行了1,373个气管插管（661个预体和712个后的后勤）。在2个月内，在实施后达到预定义的粘附阈值（> 80％的原发性气管插管），在整个后的后期持续超过70％。在患者人口统计数据，困难的气道特征或提供者之间没有观察到显着差异。呼吸和程序适应症在预领取期间更为常见。在后期后更频繁地使用视频喉镜装置（预先5％VS柱75％; P <0.001）。在送牛氧化实施后的气管插管中观察到少于80％的中等氧气去饱和度（第15.4％的11.8％术后; P = 0.049）;在实施后，还观察到少于70％的严重氧气去饱和度较少的气管插管（第10.4％Vs Post 7.2％; P = 0.032）。血液动力学气管插管相关事件（即心脏骤停，低血压，不良血症）不变（第3.2％VS Post 2.0％; P = 0.155）。多变量分析显示脂肪氧化实施与中等除霜的降低显着相关（调节的差距，0.55; 95％CI，0.34-0.88），并且严重的去饱和度小于70％（调整的赔率比，0.54; 95; 95 ％CI，0.31-0.96）调整气管插管指示和装置。结论：在PICU中实施通风氧合是可行的，并且与中等和严重的氧气去饱和度显着降低有关。在注入严重的儿童时，应考虑使用牛桂氧合。

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