Intubación prehospitalaria en trauma

Intubación prehospitalaria en el paciente moderadamente lesionado: ¿Una causa de morbilidad? Un análisis de pares compatibles de 1,200 pacientes del Registro de Trauma DGU. Prehospital intubation of the moderately injured patient: a cause of morbidity? A matched-pairs analysis of 1200 patients from the DGU Trauma Registry. Hussmann B, Lefering R, Waydhas C, Ruchholtz S, Wafaisade A, Kauther MD, Lendemans S, Trgats TR. Crit Care. 2011 Sep 13;15(5):R207. [Epub ahead of print] Abstract INTRODUCTION: Hypoxia and hypoxemia can lead to an unfavorable outcome after severe trauma, via both direct and delayed mechanisms. Prehospital intubation is meant to ensure pulmonary gas exchange. Limited evidence exists regarding indications for intubation following trauma. The aim of this study was to analyze prehospital intubation as an independent risk factor for the posttraumatic course of moderately injured patients. Therefore, only patients who, in retrospect, would not have required intubation were included in the matched-pairs analysis to evaluate the risks related to intubation. METHODS: The data of 42,248 patients taken from the trauma registry of the German Association for Trauma Surgery (Deutsche Gesellschaft fur Unfallchirurgie [DGU]) were analyzed. Patients who met the following criteria were included: primary admission to a hospital; Glasgow Coma Scale (GCS) of 13 to 15; age [greater than or equal to] 16 years; maximum injury severity per body region (AIS) [less than or equal to] 3; no administration of packed red blood cell units in the emergency trauma room; admission between 2005 and 2008; and documented data regarding intubation. The intubated patients were then matched with non-intubated patients. RESULTS: The study population included 600 matched pairs that met the inclusion criteria. The results indicated that prehospital intubation was associated with a prolonged rescue time (not intubated: 64.8 min.; intubated: 82.3 min.; P [less than or equal to] 0.001) and a higher volume replacement (not intubated: 911.3 ml; intubated: 1,573.8 ml; P [less than or equal to] 0.001). In the intubated patients, coagulation parameters, such as the prothrombin time ratio (PT) and platelet count, declined, as did the hemoglobin value (PT non-intubated: 92.3 %; intubated: 85.7 %; P [less than or equal to] 0.001; hemoglobin non-intubated: 13.4 mg/dl; intubated: 12.2 mg/dl; P [less than or equal to] 0.001). Intubation at the scene resulted in an elevated sepsis rate (non-intubated: 1.5 %; intubated: 3.7 %; P [less than or equal to] 0.02) and an elevated prevalence of multiorgan failure (MOF) and organ failure (OF) (OF non-intubated: 9.1 %; intubated: 23.4 %; P [less than or equal to] 0.001). CONCLUSIONS: Prehospital intubation in trauma patients is associated with a number of risks and should be critically weighed, except in cases with clear indicators, such as posttraumatic apnea. http://ccforum.com/content/15/5/R207/abstract    Intubación fuera del quirófano: studio multicéntrico prospectivo de práctica clínica y eventos adversos Out-of-theatre tracheal intubation: prospective multicentre study of clinical practice and adverse events T. M. Bowles1, D. A. Freshwater-Turner, D. J. Janssen, C. J. Peden  on behalf of the RTIC Severn Group Br. J. Anaesth. (2011) 107 (5): 687-692. doi: 10.1093/bja/aer251 Background Tracheal intubation is commonly performed outside the operating theatre and is associated with higher risk than intubation in theatre. Recent guidelines and publications including the 4th National Audit Project of the Royal College of Anaesthetists have sought to improve the safety of out-of-theatre intubations. Methods We performed a prospective observational study examining all tracheal intubations occurring outside the operating theatre in nine hospitals over a 1 month period. Data were collected on speciality and grade of intubator, presence of essential safety equipment and monitoring, and adverse events. Results One hundred and sixty-four out-of-theatre intubations were identified (excluding those where intubation occurred as part of the management of cardiac arrest). The most common indication for intubation was respiratory failure [74 cases (45%)]. Doctors with at least 6 month's experience in anaesthesia performed 136 intubations (83%); consultants were present for 68 cases (41%), and overall a second intubator was present for 94 procedures (57%). Propofol was the most common induction agent [124 cases (76%)] and 157 patients (96%) received neuromuscular blocking agents. An airway rescue device was available in 139 cases (87%). Capnography was not used in 52 cases (32%). Sixty-four patients suffered at least one adverse event (39%) around the time of tracheal intubation. Conclusions Out-of-theatre intubation frequently occurs in the absence of essential safety equipment, despite the existing guidelines. The associated adverse event rate is high http://bja.oxfordjournals.org/content/107/5/687.full.pdf+html

Atentamente Dr. Juan Carlos Flores-Carrillo Anestesiología y Medicina del Dolor www.anestesia-dolor.org