Effects of analgesic and sedation management in critical care medicine on patients with severe burns combined with inhalation injuries and the factors affecting tracheal intubation time
10.3760/cma.j.cn501225-20240625-00248
- VernacularTitle:重症镇痛镇静管理对严重烧伤合并吸入性损伤患者的影响及患者置管时间的影响因素
- Author:
Yanyan PAN
1
;
Youfen FAN
1
Author Information
1. 宁波市第二医院烧伤科，宁波 315000
- Publication Type:Journal Article
- Keywords:
Burns;
Analgesia;
Interrupted time series analysis;
Root cause analysis;
Inhalation injuries;
Sedation
- From:
Chinese Journal of Burns
2024;40(12):1123-1131
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the effects of analgesic and sedation management in critical care medicine on patients with severe burns combined with inhalation injuries and the factors affecting the tracheal intubation time.Methods:The study was a historical controlled study. A total of 157 patients with severe burns combined with inhalation injuries who met the inclusion criteria were admitted to the Department of Burns of Ningbo No. 2 Hospital from January 2017 to December 2022, including 126 males and 31 females, aged 14-87 years. Medical records of patients were collected before adopting the analgesic and sedation management in critical care medicine from January 2017 to December 2019 (before intervention, 77 patients) and after adopting the analgesic and sedation management in critical care medicine from January 2020 to December 2022 (after intervention, 80 patients), including the total burn area, degree of inhalation injury, abbreviated burn severity index (ABSI) score, and other general information; the number of patients, dosage, and days of using analgesic drugs (tramadol, fentanyl, and remifentanil), and the total cases and days of analgesia; the number of patients, dosage, days of using sedative drugs (midazolam, dexmedetomidine, and lytic cocktail), and the total cases and days of sedation; the days of tracheal intubation, hospitalization costs, cases and days of mechanical ventilation, and incidence of complications (secondary pneumonia and hypotension). The effects of analgesic and sedation management in critical care medicine on the time of tracheal intubation were analyzed using the interrupted time-series (ITS) analysis and univariate Fine-Gray competing risk model, and the independent factors affecting the time of tracheal intubation were screened using univariate and multivariate Fine-Gray competing risk model.Results:There were no significant differences in the total burn area, degree of inhalation injury, and ABSI score between patients before and after intervention ( P>0.05). The total sedation days and total analgesia days in patients after intervention were 7.0 (2.0, 14.0) and 7.0 (4.0, 14.0) d, respectively, which were significantly more than 3.0 (1.0, 5.0) and 4.0 (3.0, 7.0) d in patients before intervention (with Z values of -2.84 and -2.91, respectively, P<0.05). Compared with those in patients before intervention, the proportions of patients and days of using midazolam and fentanyl were significantly higher (with χ2 values of 5.68 and 6.19, Z values of -3.67 and -2.16, respectively, P<0.05), and the proportion of patients using tramadol was significantly higher ( χ2=6.57, P<0.05), while the dosage of dexmedetomidine and the proportion of patients using lytic cocktail were significantly lower after intervention ( Z=-2.17, χ2=14.54, P<0.05). The day of tracheal intubation in patients after intervention was 15.0 (9.0, 31.0) d, which was significantly more than 12.0 (9.0, 16.5) d before intervention ( Z=-2.57, P<0.05). Compared with those in patients before intervention, the hospitalization costs, the proportion of patients and days of undergoing mechanical ventilation, and the proportion of patients with secondary pneumonia were significantly increased in patients after intervention ( Z=-2.62, χ2=8.79, Z=-3.80, χ2=8.67, P<0.05). ITS analysis showed that the days of tracheal intubation in patients decreased by 0.57 d per half year before intervention ( P<0.05), and the days of tracheal intubation increased by 0.62 d per half year after intervention ( P<0.05). The analysis of univariate Fine-Gray competing risk model showed that after controlling the competing risk event, the day of tracheal intubation in patients in before intervention was significantly shorter than that after intervention ( Z=44.81, P<0.05). Multivariate Fine-Gray competing risk model analysis showed that the ABSI score, underlying disease, and days of using midazolam were the independent factors affecting the days of tracheal intubation (with risk ratios of 0.67, 0.34, and 1.93, 95% confidence intervals of 0.66-0.73, 0.16-0.73, and 1.04-3.60, respectively, P<0.05). Conclusions:After adopting the analgesic and sedation management in critical care medicine in patients with severe burns and inhalation injury, the total days of analgesia and sedation were significantly prolonged, and the days of tracheal intubation, days of mechanical ventilation, and hospitalization costs are increased. The proportions of patients receiving mechanical ventilation and the incidence of secondary pneumonia are also increased. The ABSI score, underlying disease, and days of using midazolam are the independent factors affecting the time of tracheal intubation.
