Association of blood pressure changes with survival after paramedic rapid sequence intubation in out‐of‐hospital patients with stroke

2020 ◽  
Author(s):  
Pieter F Fouche ◽  
Paul A Jennings ◽  
Malcolm Boyle ◽  
Stephen Bernard ◽  
Karen Smith
Keyword(s):  
Blood Pressure ◽  
Rapid Sequence Intubation ◽  
Rapid Sequence ◽  
Hospital Patients ◽  
Pressure Changes

Temporal changes in blood pressure following prehospital rapid sequence intubation

2021 ◽  
pp. emermed-2020-210887
Author(s):  
Pieter Francsois Fouche ◽  
Ben Meadley ◽  
Toby StClair ◽  
Alison Winnall ◽  
Christopher Stein ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Median Number ◽  
Rapid Sequence Intubation ◽  
Trauma Patients ◽  
Shock Index ◽  
Fractional Polynomial ◽  
Rapid Sequence ◽  
Transient Elevation ◽  
Pressure Changes

BackgroundRapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan.MethodsIntensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10. This retrospective cohort study analysed data from patientcare records for patients aged 12 years and above that had received RSI, from 1 January 2008 to 31 December 2019. This study quantifies the systolic blood pressure changes using regression with fractional polynomial terms. The analysis is further stratified by high versus Low Shock Index (LSI). The shock index is calculated by dividing pulse rate by systolic blood pressure.ResultsDuring the study period RSI was used in 8613 patients. The median number of blood pressure measurements was 5 (IQR 3–8). Systolic blood pressure rose significantly by 3.4 mm Hg (p<0.001) and then returned to baseline in the first 5 min after intubation for LSI cases. No initial rise in blood pressure is apparent in High Shock Index (HSI) cases. Across the whole cohort, systolic blood pressure decreased by 7.1 mm Hg (95% CI 7.9 to 6.3 mm Hg; p<0.001) from the first to the last blood pressure measured.ConclusionsOur study shows that in RSI patients a small transient elevation in systolic blood pressure in the immediate postintubation period is found in LSI, but this elevation is not apparent in HSI. Blood pressure decreased over the prehospital phase in RSI patients with LSI, but increased for HSI cases.

scholarly journals Push-Dose Pressors During Peri-intubation Hypotension in the Emergency Department: A Case Series

2021 ◽  
Vol 5 (4) ◽  
pp. 390-393
Author(s):  
Abdullah Bakhsh ◽  
Leena Alotaibi
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Mean Arterial Pressure ◽  
Side Effects ◽  
Case Series ◽  
Rapid Sequence Intubation ◽  
Emergency Physicians ◽  
Rapid Sequence ◽  
Lethal Complications ◽  
The Mean

Introduction: Emergency physicians frequently encounter critically ill patients in circulatory shock requiring definitive airway procedures. Performing rapid sequence intubation in these patients without blood pressure correction has lethal complications. Questioning the efficacy and fearing side effects of push-dose pressors (PDP) has created an obstacle for their use in the emergency department (ED) setting. In this case series we describe the efficacy and side effects of PDP use during peri-intubation hypotension in the ED. Case series: We included 11 patients receiving PDPs in this case series. The mean increase in systolic blood pressure was 41.3%, in diastolic blood pressure 44.3%, and in mean arterial pressure 35.1%. No adverse events were documented in this case series. Conclusion: The use of push-dose pressors during peri-intubation hypotension may potentially improve hemodynamic status when used carefully in the ED.

Sedation for Nonemergent Neonatal Intubation

2001 ◽  
Vol 20 (7) ◽  
pp. 19-23 ◽  
Author(s):  
Scott DeBoer ◽  
Lisa Peterson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Critical Care ◽  
Intracranial Pressure ◽  
Standard Of Care ◽  
Pediatric Emergency ◽  
Rapid Sequence Intubation ◽  
Rapid Sequence ◽  
Wide Awake ◽  
Neonatal Population

A newborn lies wide-awake, about to be intubated. The infant is able to feel everything, to hear everything—but cannot do anything to change the situation. Big people hold down the newborn and place a laryngoscope blade into the mouth, then a large endotracheal tube into the trachea. As the baby struggles, coughs, chokes, gags, and cries, blood pressure and intracranial pressure increase dramatically, and the heart rate plummets.Infants, like adults, do feel pain and anxiety. Yet recent studies show that NICU staff continue neonatal intubation utilizing only force. In pediatric emergency/critical care settings, rapid-sequence intubation (RSI), once confined to the environment of the operating room, is now the standard of care. An understanding of commonly administered RSI medications is essential to bring this practice to standard use in the NICU as well.In the pediatric and adult critical care population, rapidsequence intubation (RSI)—the use of sedatives and chemical paralytics to facilitate tracheal intubation—is considered the standard of care. Use of these medications optimizes intubating conditions and helps to minimize the adverse physiologic effects of intubation. Neonatology has yet to embrace this trend, however. This article addresses the issue of sedation for intubation in the neonatal population.

Prehospital Rapid Sequence Intubation in an Emergency Medical Services System with Two Advanced Life Support Providers

2010 ◽  
Vol 25 (4) ◽  
pp. 341-345 ◽  
Author(s):  
Mark A. Merlin ◽  
Huma Safdar ◽  
Susan Calabrese ◽  
Alex Lewinsky ◽  
Joseph Manfre ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pulse Oximetry ◽  
Life Support ◽  
Advanced Life Support ◽  
Rapid Sequence Intubation ◽  
Success Rates ◽  
Rapid Sequence ◽  
Intubation Success ◽  
End Tidal

AbstractObjective:A rapid sequence intubation (RSI) method was introduced to a university-based emergency medical services (EMS) system. This is a report of the initial experience with the first 50 patients in a unique, two-tiered, two-advanced life support (ALS) providers system.Methods:The data were evaluated prospectively after an extensive RSI training period, consisting of didactic information and skills performance. Fifty consecutive patient records that documented the procedure were abstracted. Data abstracted included end-tidal CO2, heart rate, blood pressure, and pulse oximetry at various time intervals. Intubation success rates and number of attempts were documented. The consistency of proper documentation also was noted on patient care records.Results:No differences were noted in heart rate prior to RSI and one and five minutes after the RSI procedure was begun. No differences in blood pressure at one and five minutes were noted. Statistically significant improvements were found in pulse oximetry comparing prior to RSI and one minute after (p < 0.001; 95% CI = 3.15–11.41) as well as prior to RSI and five minutes after RSI was started (p < 0.0002; 95% CI = 4.60–13.33). No differences were observed in end-tidal CO2 at one and five minutes. Overall intubation success rate was 96%, with 82% on first attempt and 92% on two or less attempts. Documentation for individual vitals was consistently <75%.Conclusions:Patients had no significant worsening of vital signs during the RSI procedure and mild improvement in pulse oximetry. Intubation success rates were consistent with national averages. Proper documentation was lacking in more than one quarter of the charts. These data add to a body of literature that raises further concerns regarding prehospital RSI.

scholarly journals Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?

CJEM ◽  
2001 ◽  
Vol 3 (04) ◽  
pp. 302-310 ◽  
Author(s):  
Kerry Wilbur ◽  
Peter J. Zed
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Direct Current ◽  
Procedural Sedation ◽  
Rapid Sequence Intubation ◽  
Efficacy And Safety ◽  
Intubating Conditions ◽  
Direct Current Cardioversion ◽  
Rapid Sequence ◽  
Recovery Times

ABSTRACTObjective:We conducted a qualitative systematic review to evaluate the efficacy and safety of propofol for direct current cardioversion (DCC), rapid sequence intubation (RSI) and procedural sedation in adult emergency department (ED) patients.Data source:MEDLINE (1966 to September 2000), PubMed (to September 2000), EMBASE (1988 to September 2000), Database of Systematic Reviews (to September 2000), Best Evidence (1991 to September 2000) and Current Contents (1996 to September 2000) databases.Study selection:English-language, randomized, comparative evaluations of propofol for procedures routinely conducted in adults (&gt;18 years) were included. Direct current cardioversion, RSI and procedural sedation were considered.Data extraction:Efficacy and safety endpoints were evaluated for all trials. For DCC and procedural sedation trials, efficacy measures included induction and recovery times, as well as the association for successful procedure. For the RSI trials, optimal intubating conditions were evaluated as the primary efficacy endpoint. Safety measures included hemodynamic changes, apnea rates and adverse effects.Data synthesis:In the setting of DCC, efficacy and safety outcomes were similar for propofol, thiopental, etomidate and methohexital. All of these agents provided markedly shorter induction and recovery times than midazolam. Patients who were pre-medicated with fentanyl exhibited prolonged recovery times and greater decreases in blood pressure. When used for RSI, propofol administration was associated with satisfactory intubating conditions that were comparable to those seen with thiopental and etomidate. Blood pressure reductions were seen in both DCC and RSI studies. Apneic episodes (&gt;30 seconds) occurred in 23% of propofol recipients, 28% of thiopental recipients and 7% of etomidate and midazolam recipients. Apart from the DCC studies described, no procedural sedation studies met our predefined review eligibility criteria.Conclusion:The body of literature evaluating propofol for DCC and RSI in the ED is limited. There is evidence to support the use of propofol for DCC and RSI, but this evidence comes from stable patients in non-ED settings. Further ED-based randomized comparative trials should be conducted before propofol is adopted for widespread use in the ED.

Heart Rate Signal Decomposition

2000 ◽  
Vol 39 (02) ◽  
pp. 200-203
Author(s):  
H. Mizuta ◽  
K. Yana
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pressure Change ◽  
Normal Subjects ◽  
Signal Decomposition ◽  
Large Individual ◽  
Heart Rate Fluctuations ◽  
Type Pattern ◽  
Signal Cancellation ◽  
Pressure Changes

Abstract:This paper proposes a method for decomposing heart rate fluctuations into background, respiratory and blood pressure oriented fluctuations. A signal cancellation scheme using the adaptive RLS algorithm has been introduced for canceling respiration and blood pressure oriented changes in the heart rate fluctuations. The computer simulation confirmed the validity of the proposed method. Then, heart rate fluctuations, instantaneous lung volume and blood pressure changes are simultaneously recorded from eight normal subjects aged 20-24 years. It was shown that after signal decomposition, the power spectrum of the heart rate showed a consistent monotonic 1/fa type pattern. The proposed method enables a clear interpretation of heart rate spectrum removing uncertain large individual variations due to the respiration and blood pressure change.

Sign in / Sign up

Export Citation Format

Share Document