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Tytuł:
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Rapid Sequence Induction Strategies Among Critically Injured U.S. Military During the Afghanistan and Iraq Conflicts.
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Autorzy:
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Emerling AD; Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
Bianchi W; Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
Krzyzaniak M; Department of General Surgery, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
Deaton T; Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
Via D; Director, Medical Systems Integration and Combat Survivability, N44, Chief of Naval Operations, 2000 Navy Pentagon, Room 2E274, Washington DC 20350, USA.
Archer B; Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
Sutherland J; Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
Shannon K; Department of Operational Readiness, Naval Health Research Center, Bldg. 329, Ryne Rd, San Diego, CA, 92152, USA.
Dye JL; Department of Operational Readiness, Naval Health Research Center, Bldg. 329, Ryne Rd, San Diego, CA, 92152, USA.
Clouser M; Department of Operational Readiness, Naval Health Research Center, Bldg. 329, Ryne Rd, San Diego, CA, 92152, USA.
Auten JD; Department of Emergency Medicine, Naval Medical Center San Diego, Naval Medical Center San Diego Combat Trauma Research Group, San Diego, CA, 92134.
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Źródło:
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Military medicine [Mil Med] 2021 Jan 25; Vol. 186 (Suppl 1), pp. 316-323.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2018- : Oxford : Oxford University Press
Original Publication: Washington, D.C. : Association of Military Surgeons, United States, 1955-
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MeSH Terms:
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Military Personnel*
Afghanistan ; Humans ; Injury Severity Score ; Iraq ; Rapid Sequence Induction and Intubation ; Retrospective Studies ; Wounds and Injuries/complications ; Wounds and Injuries/therapy
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Entry Date(s):
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Date Created: 20210127 Date Completed: 20210416 Latest Revision: 20210701
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Update Code:
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20240105
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DOI:
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10.1093/milmed/usaa356
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PMID:
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33499492
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Introduction: Rapid sequence intubation of patients experiencing traumatic hemorrhage represents a precarious phase of care, which can be marked by hemodynamic instability and pulseless arrest. Military combat trauma guidelines recommend reduced induction dose and early blood product resuscitation. Few studies have evaluated the role of induction dose and preintubation transfusion on hemodynamic outcomes. We compared rates of postintubation systolic blood pressure (SBP) of < 70 mm Hg, > 30% drop in SBP, pulseless arrest, and mortality at 24 hours and 30 days among patients who did and did not receive blood products before intubation and then examined if induction agent and dose influenced the same outcomes.
Materials and Methods: A retrospective analysis was performed of battle-injured personnel presenting to surgical care facilities in Iraq and Afghanistan between 2004 and 2018. Those who received blood transfusions, underwent intubation, and had an Injury Severity Score of ≥15 were included. Intubation for primary head, facial, or neck injury, burns, operative room intubations, or those with cardiopulmonary resuscitation in progress were excluded. Multivariable logistic regression was performed with unadjusted and adjusted odds ratios for the five study outcomes among patients who did and did not receive preintubation blood products. The same analysis was performed for patients who received full or excessive versus partial induction agent dose.
Results: A total of 153 patients had a mean age of 24.9 (SD 4.5), Injury Severity Score 29.7 (SD 11.2), heart rate 122.8 (SD 24), SBP 108.2 (SD 26.6). Eighty-one (53%) patients received preintubation blood products and had similar characteristics to those who did not receive transfusions. Adjusted multivariate analysis found odds ratios as follows: 30% SBP decrease 9.4 (95% CI 2.3-38.0), SBP < 70 13.0 (95% CI 3.3-51.6), pulseless arrest 18.5 (95% CI 1.2-279.3), 24-hour mortality 3.8 (95% CI 0.7-21.5), and 30-day mortality 1.3 (0.4-4.7). In analysis of induction agent choice and comparison of induction agent dose, no statistically significant benefit was seen.
Conclusion: Within the context of this historical cohort, the early use of blood products conferred a statistically significant benefit in reducing postintubation hypotension and pulseless arrest among combat trauma victims exposed to traumatic hemorrhage. Induction agent choice and dose did not significantly influence the hemodynamic or mortality outcomes.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Erratum in: Mil Med. 2021 Jul 1;186(7-8):e843. (PMID: 33904575)