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Caractéristiques des patients hémodynamiquement instables avant induction (N=54), EPIDEMIOLOGIE ET PRISE EN CHARGE ,
Peu de données sont disponibles sur l'évolution hémodynamique des patients intubés après induction en séquence rapide (ISR) Les hypotensions post ISR (HPI) sont expliquées par la sédation et le collapsus de reventilation. L'hypotension préhospitalière est un facteur de morbimortalité. L'objectif est d'analyser l'incidence de l'HPI, ses facteurs favorisants et sa prise en charge par les médecins SMUR. Matériel et méthodes Etude observationnelle prospective bicentrique préhospitalière. Tous les patients intubés après ISR ont été inclus, Les pressions artérielles ,
Aucune baisse significative de PAS n'a été constatée chez les traumatisés crâniens. 38% des patients ont présenté au moins une HPI (PAS<90mmHg) :90% ont bénéficié d'une mesure correctrice (remplissage seul 30%, remplissage+catécholamines 54%) 51% des patients qui n'ont pas fait d'HPI avaient bénéficié d'un remplissage pré ISR (79% dans le groupe TC).L'hypotension était corrigée chez 35% des patients en état de choc avant induction. Les facteurs associés à l'HPI en analyse multivariée sont l'âge, l'état de choc et une PEEP>5cmH2O. La curarisation à l'induction et en entretien semble protectrice, PAS) baisse significativement par rapport à la PA initiale Conclusion Les HPI sont fréquentes. Le traumatisé crânien bénéficie d'une attention particulière. Cependant, l'anticipation de l'HPI peut être améliorée. L'étude souligne la nécessité de sensibiliser les médecins SMUR aux mesures préventives et correctrices de l'HPI ,
Intubation is a core element of critical care support Little information has been published on the hemodynamic profiles of patients undergoing pre-hospital intubation. However, pre-hospital hypotension has been shown as an important predictor for morbimortality, especially in patients with traumatic brain injury (TBI) The objectives of this study were to determine the incidence, risk factors of post induction hypotension (PIH) and its management Material and methods Prospective multicenter observational study of patients that underwent pre-hospital RSI. Blood pressure (BP) was measured every 2 minutes during 30 minutes following induction. Results 307 patients were included. Systolic BP dropped significantly at the 8 th min after RSI (p<0,01). No significant drop was observed among TBI patients. 38%of patients had at least one HPI: 90% were treated, 30%by fluid load only, 54% by fluid load and catécholamines. 51% of patients remained normotensives have been preload before RSI (79% among TBI). 35%of preRSI shoked patients became normotensive after RSI. Using multivariate analysis, the presence of shock before RSI, age, PEEP>5cmH2O were predictive of PIH. Curare use during induction and maintenance were protective factors. Conclusion HPI occurs fréquently, Mots clés : Induction en séquence rapide ,