A research of tracheal intubations optimization for severe brain injury patients

Objective To explore the optimization of intubations for severe brain injury patients in ICU. Methods Seventy-six severe brain injury patients were divided into research group and traditional group through the envelop method, with 38 patients in each group. Patients in research group was induced by dexmedetomidine, while patients in traditional group was induced by midazolam or propofol. Throat and intratrachea surface anesthesia was taken with 3 ml of 1% lidocaine on two groups before intubation, and they were intubated through direct laryngoscope. Patients were connected with breathing machines after intubation, and the arterial carbondioxide partial pressure was maintained at 30 - 35 mmHg (1 mmHg = 0.133 kPa). Intubations time, one-time success rate, cardiovascular reaction index, myocardial damage and heart failure biomarkers, adverse reaction, patients comfort and intubationists satisfaction of the two groups were compared. Results The intubation time on research group was significantly shorter than that on traditional group [(27.1 ± 14.2) s vs. (42.2 ± 18.7) s], and there was statistical significance (P 0.05). The heart rates and mean arterial pressure (MAP) at pre-intubation, post-intubation, 5 min after intubation and 10 min after intubation in research group were significantly lower than those in traditional group: heart rate: (77.8 ± 8.5) bpm vs. (85.1 ± 7.6) bpm, (85.3 ± 9.1) bpm vs. (106.4 ± 12.5) bpm, (84.4 ± 10.4) bpm vs. (96.4 ± 11.9) bpm, (80.5 ± 12.1) bpm vs. (89.0 ± 10.5) bpm; MAP: (82.6 ± 10.1) mmHg (1 mmHg = 0.133 kPa) vs. (93.2 ± 14.3) mmHg, (88.3 ± 13.2) mmHg vs. (113.7 ± 15.1) mmHg, (85.4 ± 14.0) mmHg vs. (101.3 ± 9.9) mmHg, (83.7 ± 10.7) mmHg vs. (90.3 ± 13.4) mmHg, and there were statistical significances (P 0.05). For 6 and 12 h after intubation, creatine kinase isoenzyme MB (CK-MB), cardiac troponin T (cTnT) and brain natriuretic peptide (BNP) levels in research group were significantly lower than those in traditional group: CK-MB: (30.5 ± 7.2) U/L vs. (35.2 ± 10.1) U/L, (25.7 ± 5.7) U/L vs. (27.7 ± 6.5) U/L; cTnT: (0.6 ± 0.2) µg/L vs. (0.8 ± 0.1) µg/L, (0.5 ± 0.2) µg/L vs. (0.6 ± 0.2) µg/L; BNP:(152.6 ± 13.7) pg/L vs. (189.4 ± 19.3) pg/L, (89.7 ± 27.5) pg/L vs. (111.8 ± 20.4) pg/L, and there were statistical significances (P <0.05). There were no significant adverse reactions in two groups after topical anesthesia. The comfort and intubationists satisfaction scores in research group were significantly higher than those in traditional group: (2.5 ± 0.4) scores vs. (1.8 ± 0.5) scores and (8.8 ± 1.1) scores vs. (7.1 ± 0.9) scores, and there were statistical significance (P < 0.01). Conclusions Combining dexmedetomidine induction with topical anesthesia to intubate is safe and effective, which is the optimization of tracheal intubations to severe brain injury patients. Key words: Brain injuries; Dexmedetomidine; Intubation, intratracheal tracheal; Prospective studies