Rocuronium dose and first-attempt intubation success in the critically ill: secondary analysis of two multicenter trials.

Background

To evaluate the association between rocuronium dose and tracheal intubation outcomes among adults undergoing emergency tracheal intubation in the emergency department (ED) and intensive care unit (ICU).

评估罗库溴铵剂量与在急诊科（ED）和重症监护病房（ICU）接受紧急气管插管的成人患者气管插管结果之间的关联。

Methods

We conducted a secondary analysis of data from two multicenter randomized controlled trials studying airway management in the ED and ICU.

我们对两项在急诊室和ICU研究气道管理的多中心随机对照试验的数据进行了二次分析。

We compared patient characteristics and intubation outcomes between patients receiving high-dose (>1.2 mg/kg) versus standard-dose (≤1.2 mg/kg) rocuronium.

我们比较了接受高剂量（>1.2 mg/kg）与标准剂量（≤1.2 mg/kg）罗库溴铵的患者的特征和插管结果。

The primary outcome was successful intubation on the first attempt.

主要结果是首次尝试成功插管。

We used propensity matching to account for measured potential confounders, stratified by setting.

我们使用倾向性匹配来考虑测量的潜在混杂因素，按设置分层。

measurements_and_main_results

Participating sites included 9 EDs and 24 ICUs in the United States.

参与的站点包括美国的9个急诊科和24个重症监护室。

Among 2440 patients in the trial datasets, we included the 1822 (74.7%) patients who received rocuronium in the current analysis.

在试验数据集中的2440名患者中，我们纳入了当前分析的1822名（74.7%）接受罗库溴铵治疗的患者。

Of these, 720 (39.5%) received high-dose rocuronium, and 1102 (60.5%) received standard-dose rocuronium.

在这些患者中，720名（39.5%）接受了高剂量的罗库溴铵，而1102名（60.5%）接受了标准剂量的罗库溴铵。

Participants receiving high-dose rocuronium had a higher probability of successful intubation on the first attempt (adjusted relative risk [RR] 1.07, 95% confidence interval[CI] 1.02-1.12).

接受高剂量罗库溴铵的参与者在首次尝试插管时成功的概率更高（调整后的相对风险[RR] 1.07，95%置信区间[CI] 1.02-1.12）。

This difference in the primary outcome was not present for ED intubations (adjusted RR 0.97, 95% CI 0.89-1.04) but was present for ICU intubations (adjusted RR 1.13, 95% CI 1.06-1.20).

主要结果的这种差异在急诊插管中不存在（调整后的相对风险 RR 0.97, 95% 置信区间 CI 0.89-1.04），但在重症监护病房（ICU）插管中存在（调整后的相对风险 RR 1.13, 95% 置信区间 CI 1.06-1.20）。

Conclusions

In this secondary analysis, high-dose rocuronium (>1.2 mg/kg) was associated with higher first-attempt success.

在这项次要分析中，高剂量的罗库溴铵（>1.2 mg/kg）与首次尝试成功率较高相关。

Given the potential for unmeasured confounding, these findings warrant evaluation in a randomized controlled trial.

鉴于存在未测量混杂因素的潜力，这些发现需要在随机对照试验中进行评估。