科研之友
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摘要
Background: Atropine has is currently recommended to facilitate haemodynamic stability during critical care intubation. Our objective was to determine whether atropine use at induction influences ICU mortality. %26lt;br%26gt;Methodology/Principal Findings: A 2-year prospective, observational study of all first non-planned intubations, September 2007-9 in PICU and Intensive Care Transport team of Hopital Robert Debre, Paris, 4 other PICUs and 5 NICUs in the Paris Region, France. Follow-up was from intubation to ICU discharge. A propensity score was used to adjust for patient specific characteristics influencing atropine prescription. 264/333 (79%) intubations were included. The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95% CI 0.19-0.95, p = 0.04). One child died during intubation (1/264, 0.4%). Two age sub-groups of neonates (# 28 days) and older children (%26gt;28 days, %26lt;8 years) were examined. This difference in mortality arose from the higher mortality in children aged over one month when atropine was not used (propensity score adjusted OR 0.22, 95% CI 0.06-0.85, p = 0.028). No effect was seen in neonates (propensity score adjusted OR 1.3, 95% CI 0.31-5.1 p = 0.74). Using the propensity score, atropine maintained the mean heart rate 45.9 bpm above that observed when no atropine was used in neonates (95% CI 34.3-57.5, p, 0.001) and 43.5 bpm for older children (95% CI 25.5-61.5 bpm, p%26lt;0.001). %26lt;br%26gt;Conclusions/Significance: Atropine use during induction was associated with a reduction in ICU mortality in children over one month. This effect is independent of atropine%26apos;s capacity to attenuate bradycardia during intubation which occurred similarly in neonates and older children. This result needs to be confirmed in a study using randomised methodology.
- 出版日期2013-2-28
