Rocuronium dose and first-attempt intubation success in the critically ill: secondary analysis of two multicenter trials.
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April Michael D, Butler Harris, Demasi Stephanie C, Aggarwal Neil R, Andrea Luke J, Barker Andrew B, Barnes Christopher R, Brainard Jason C, Brewer Joseph Michael, Driver Brian E, Gaillard John P, Gandotra Sheetal, Ghamande Shekhar A, Gibbs Kevin W, Herbert James Taylor, Hughes Christopher G, Janz David R, Joffe Aaron M, Khan Akram, Kramer Patrick J, Latimer Andrew J, Mitchell Steven H, Moskowitz Ari L, Page David B, Prekker Matthew E, Resnick-Ault Daniel, Self Wesley H, Smith Lane M, Sottile Peter D, Stempek Susan B, Trent Stacy A, Vonderhaar Derek J, Walker James E, White Heath D, Semler Matthew W, Casey Jonathan D, Schauer Steven G, Ginde Adit A
Аннотация
OBJECTIVES: 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).
METHODS: We conducted a secondary analysis of data from two multicenter randomized controlled trials studying airway management in the ED and ICU. We compared patient characteristics and intubation outcomes between patients receiving high-dose (>1.2 mg/kg) versus standard-dose (≤1.2 mg/kg) rocuronium. The primary outcome was successful intubation on the first attempt. We used propensity matching to account for measured potential confounders, stratified by setting.
MEASUREMENTS AND MAIN RESULTS: Participating sites included 9 EDs and 24 ICUs in the United States. Among 2440 patients in the trial datasets, we included the 1822 (74.7%) patients who received rocuronium in the current analysis. Of these, 720 (39.5%) received high-dose rocuronium, and 1102 (60.5%) received standard-dose rocuronium. 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). 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).
CONCLUSIONS: In this secondary analysis, high-dose rocuronium (>1.2 mg/kg) was associated with higher first-attempt success. Given the potential for unmeasured confounding, these findings warrant evaluation in a randomized controlled trial.