Levitan R M, Kush S, Hollander J E
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Ann Emerg Med. 1999 Jun;33(6):694-8.
We conducted a national survey of emergency medicine residency program directors to determine which alternative devices were available in their emergency departments for difficult airway management. We also assessed the residency directors' experience in use of these devices.
After approval was received from the institutional review board at our institution, residency directors were contacted by mail, fax, or phone in October 1997. Alternative intubation devices were defined as devices that do not involve use of a laryngoscope and direct visualization for tracheal tube placement. Alternative ventilation devices were defined as those that do not use a face mask for ventilation. We asked whether the following alternative intubation devices were stocked in their department: a flexible fiberoptic bronchoscope, a rigid fiberoptic device (ie, Bullard, Wu-Scope), a lighted stylet, or a retrograde intubation kit. We also asked about the following alternative ventilation devices: a transtracheal jet ventilation system with a 50-psi oxygen source and control valve, the esophageal tracheal twin-lumen airway device (Combitube), or the laryngeal mask airway. Residency directors were also questioned about their duration of practice, intubation experience, and use of these devices.
We obtained information from 95 of 118 (81%) programs. Of 95 programs, 61 (64%) had a fiberoptic bronchoscope, 43 (45%) a retrograde intubation kit, 33 (35%) a lighted stylet, and 6 (.06%) a rigid fiberoptic device. Forty-seven (49%) of the programs reported 2 or more devices, and 20 (21%) reported having no alternative intubation devices. Of 95 programs, 64 (67%) had a transtracheal jet ventilation system, 25 (26%) had the Combitube, and 25 (26%) had the laryngeal mask airway. Thirty-one (33%) programs had at least 2 alternative ventilation devices, and 20 (21%) had none. Ten (11%) programs had no alternative intubating or ventilation devices. Additional information on duration of practice, intubation experience, and actual use of alternative devices was obtained from 83 of the 95 (87%) emergency medicine residency directors contacted. Forty-one (49%) reported never having used an alternative device for intubation. The most commonly used alternative intubation device was the flexible fiberoptic bronchoscope (37%), and the mean number of times any alternative device was used was 7.
The availability of devices for difficult airway management varies tremendously across emergency medicine residency programs. Only half of residency program directors had any experience with these devices, and among those that reported any experience, they are used rarely.
我们对急诊医学住院医师培训项目主任进行了一项全国性调查，以确定其急诊科可用于困难气道管理的替代设备。我们还评估了住院医师培训项目主任使用这些设备的经验。
在获得本机构机构审查委员会的批准后，于1997年10月通过邮件、传真或电话联系住院医师培训项目主任。替代插管设备定义为不涉及使用喉镜和直接可视化进行气管导管置入的设备。替代通气设备定义为不使用面罩进行通气的设备。我们询问他们所在科室是否备有以下替代插管设备：柔性纤维支气管镜、刚性纤维光学设备（即Bullard喉镜、Wu-Scope喉镜）、光棒或逆行插管套件。我们还询问了以下替代通气设备的情况：配有50磅力/平方英寸氧气源和控制阀的经气管喷射通气系统、食管气管双腔气道装置（联合导管）或喉罩气道。还询问了住院医师培训项目主任的执业年限、插管经验以及这些设备的使用情况。
我们从118个项目中的95个（81%）获得了信息。在95个项目中，61个（64%）有纤维支气管镜，43个（45%）有逆行插管套件，33个（35%）有光棒，6个（6%）有刚性纤维光学设备。47个（49%）项目报告有2种或更多设备，20个（21%）报告没有替代插管设备。在95个项目中，64个（67%）有经气管喷射通气系统，25个（26%）有联合导管，25个（26%）有喉罩气道。31个（33%）项目至少有2种替代通气设备，20个（21%）没有。10个（11%）项目没有替代插管或通气设备。从所联系的95名急诊医学住院医师培训项目主任中的83名（87%）那里获得了关于执业年限、插管经验以及替代设备实际使用情况的更多信息。41名（49%）报告从未使用过替代设备进行插管。最常用的替代插管设备是柔性纤维支气管镜（37%），任何替代设备的平均使用次数为7次。
困难气道管理设备的可获得性在急诊医学住院医师培训项目中差异极大。只有一半的住院医师培训项目主任有使用这些设备的经验，而且在那些报告有任何经验的人中，这些设备很少使用。
