{"id":16891,"date":"2019-02-23T04:59:22","date_gmt":"2019-02-22T20:59:22","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=16891"},"modified":"2019-06-02T06:33:23","modified_gmt":"2019-06-01T22:33:23","slug":"nejm%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8-%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3%e8%80%85%e6%b0%94%e7%ae%a1%e6%8f%92%e7%ae%a1%e8%bf%87%e7%a8%8b%e4%b8%ad%e7%90%83%e5%9b%8a%e9%9d%a2%e7%bd%a9%e9%80%9a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=16891","title":{"rendered":"[NEJM\u5728\u7ebf\u53d1\u8868]: \u5371\u91cd\u75c5\u60a3\u8005\u6c14\u7ba1\u63d2\u7ba1\u8fc7\u7a0b\u4e2d\u7403\u56ca\u9762\u7f69\u901a\u6c14"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/h3>\n\n\n\n

Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults<\/h1>\n\n\n\n

Jonathan D. Casey, David R. Janz, Derek W. Russell, et al\u00a0<\/h3>\n\n\n\n

N Engl J Med February 18, 2019
DOI: 10.1056\/NEJMoa1812405<\/h3>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h2>\n\n\n\n

Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial.<\/p>\n\n\n\n

\u4f4e\u6c27\u8840\u75c7\u662f\u6210\u5e74\u5371\u91cd\u75c5\u60a3\u8005\u6c14\u7ba1\u63d2\u7ba1\u8fc7\u7a0b\u4e2d\u6700\u5e38\u89c1\u7684\u5e76\u53d1\u75c7\uff0c\u53ef\u80fd\u589e\u52a0\u5fc3\u8df3\u9aa4\u505c\u51e0\u6b7b\u4ea1\u98ce\u9669\u3002\u6210\u5e74\u5371\u91cd\u75c5\u60a3\u8005\u6c14\u7ba1\u63d2\u7ba1\u8fc7\u7a0b\u4e2d\uff0c\u901a\u8fc7\u7403\u56ca\u9762\u7f69\u88c5\u7f6e\u8fdb\u884c\u6b63\u538b\u901a\u6c14\u80fd\u5426\u9884\u9632\u4f4e\u6c27\u8840\u75c7\u4e14\u4e0d\u589e\u52a0\u8bef\u5438\u98ce\u9669\u5c1a\u5b58\u5728\u4e89\u8bae\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h2>\n\n\n\n

In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%.<\/p>\n\n\n\n

\u8fd9\u662f\u5728\u7f8e\u56fd7\u4e2aICU\u8fdb\u884c\u7684\u4e00\u9879\u591a\u4e2d\u5fc3\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u3002\u6211\u4eec\u5c06\u63a5\u53d7\u6c14\u7ba1\u63d2\u7ba1\u7684\u6210\u5e74\u60a3\u8005\u968f\u673a\u5206\u7ec4\uff0c\u5728\u8bf1\u5bfc\u53ca\u5589\u955c\u64cd\u4f5c\u9636\u6bb5\u5206\u522b\u63a5\u53d7\u7403\u56ca\u9762\u7f69\u901a\u6c14\u6216\u65e0\u901a\u6c14\u3002\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u8bf1\u5bfc\u81f3\u6c14\u7ba1\u63d2\u7ba1\u540e2\u5206\u949f\u5185\u7684\u6700\u4f4e\u6c27\u9971\u548c\u5ea6\u3002\u6b21\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u4e25\u91cd\u4f4e\u6c27\u8840\u75c7\u53d1\u751f\u7387\uff0c\u5b9a\u4e49\u4e3a\u6c27\u9971\u548c\u5ea6< 80%\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h2>\n\n\n\n

Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P=0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P=0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P=0.73).<\/p>\n\n\n\n

\u7814\u7a76\u5171\u5165\u9009401\u540d\u60a3\u8005\uff0c\u7403\u56ca\u9762\u7f69\u7ec4\u6700\u4f4e\u6c27\u9971\u548c\u5ea6\u4e2d\u4f4d\u6570\u4e3a96%\uff08\u56db\u5206\u4f4d\u533a\u95f4 87 to 99\uff09\uff0c\u65e0\u901a\u6c14\u7ec4\u4e3a93%\uff08\u56db\u5206\u4f4d\u533a\u95f481 to 99\uff09(P=0.01)\u3002\u7403\u56ca\u9762\u7f69\u7ec421\u540d\u60a3\u8005(10.9%)\u53ca\u65e0\u901a\u6c14\u7ec445\u540d\u60a3\u8005(22.8%)\u53d1\u751f\u4e25\u91cd\u4f4e\u6c27\u8840\u75c7\uff08\u76f8\u5bf9\u5371\u9669\u5ea6\uff0c0.48\uff1b95% \u53ef\u4fe1\u533a\u95f4 [CI], 0.30 to 0.77\uff09\u3002\u64cd\u4f5c\u8005\u62a5\u544a\u8bef\u5438\u53d1\u751f\u7387\u5728\u7403\u56ca\u9762\u7f69\u7ec4\u548c\u65e0\u901a\u6c14\u7ec4\u5206\u522b\u4e3a2.5%\u548c4.0% (P=0.41)\u3002\u6c14\u7ba1\u63d2\u7ba1\u540e48\u5c0f\u65f6\u80f8\u7247\u65b0\u53d1\u900f\u5149\u5ea6\u4e0b\u964d\u7684\u53d1\u751f\u7387\u5206\u522b\u4e3a16.4%\u548c14.8% (P=0.73)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS \u7ed3\u8bba<\/h2>\n\n\n\n

Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation.<\/p>\n\n\n\n

\u5bf9\u4e8e\u63a5\u53d7\u6c14\u7ba1\u63d2\u7ba1\u7684\u6210\u5e74\u5371\u91cd\u75c5\u60a3\u8005\uff0c\u4e0e\u65e0\u901a\u6c14\u76f8\u6bd4\uff0c\u7403\u56ca\u9762\u7f69\u901a\u6c14\u80fd\u591f\u63d0\u9ad8\u6c27\u9971\u548c\u5ea6\uff0c\u4e14\u964d\u4f4e\u4e25\u91cd\u4f4e\u6c27\u8840\u75c7\u7684\u53d1\u751f\u7387\u3002<\/p>\n\n\n\n

(Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number,\u00a0NCT03026322<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Bag-Mask Ventilation during Tracheal I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16891"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16891"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16891\/revisions"}],"predecessor-version":[{"id":16892,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16891\/revisions\/16892"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16891"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16891"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16891"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}