A retrospective data analysis on the induction medications used in trauma rapid sequence intubations and their effects on outcomes.
Induction agents
Rapid sequence intubation
Trauma
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
31
03
2021
accepted:
27
07
2021
pubmed:
7
8
2021
medline:
18
6
2022
entrez:
6
8
2021
Statut:
ppublish
Résumé
Rapid sequence intubation (RSI) in trauma patients is common; however, the induction agents used have been debated. We determined which induction medications were used most frequently for adult trauma RSIs and their associations with hemodynamics and outcomes. We hypothesized that etomidate is the most commonly used induction agent and has similar outcomes to other induction agents. This retrospective review at two U.S. level I trauma centers evaluated adult trauma patients undergoing RSI within 24 h of admission, between 01/01/2016 and 12/31/2017. We compared patient characteristics and outcomes by induction agent. Comparisons on the primary outcome of in-hospital mortality and secondary outcomes of peri-intubation hypotension, hospital and ICU length of stay (LOS), ventilator days, and complications used logistic regression or negative binomial regression. Regression models adjusted for hospital site, age, patient severity measures, and intubation location. Among 1303 trauma patients undergoing RSI within 24 h of admission, 948 (73%) were intubated in the emergency department (ED) and 325 (25%) in the operating room (OR). The most common induction agents were etomidate (68%), propofol (17%), and ketamine (11%). In-hospital mortality was highest in the etomidate group (25.5%), followed by ketamine (17%), and propofol (1.8%). Etomidate was most commonly used in ED intubations; propofol was most used in the OR. Compared to propofol, patients induced with etomidate had higher mortality and complication rates. Findings should be interpreted with caution given limited generalizability and residual confounding by indication.
Identifiants
pubmed: 34357407
doi: 10.1007/s00068-021-01759-0
pii: 10.1007/s00068-021-01759-0
pmc: PMC8343213
doi:
Substances chimiques
Ketamine
690G0D6V8H
Propofol
YI7VU623SF
Etomidate
Z22628B598
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2275-2286Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001855
Pays : United States
Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
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