Combes Xavier, Jabre Patricia, Jbeili Chadi, Leroux Bertrand, Bastuji-Garin Sylvie, Margenet Alain, Adnet Fréderic, Dhonneur Gilles
Service d'Aide Médicale Urgente, CHU Henri Mondor, Créteil, France.
Acad Emerg Med. 2006 Aug;13(8):828-34. doi: 10.1197/j.aem.2006.02.016. Epub 2006 Jun 28.
The rate of difficult intubation in prehospital emergency medicine varies greatly among studies already published and depends on several factors. The authors' objective was to determine the rate of difficult intubations and to determine factors associated with prehospital difficult airways when a standard protocol for sedation and intubation was applied.
This 30-month clinical, observational, prospective study was performed in a suburb of Paris, France (Val de Marne, population 1,300,000) by a prehospital emergency medical unit. Airway management for patients who needed tracheal intubation was standardized. The pharmacological procedure recommended rapid sequence intubation for patients with spontaneous cardiac activity. In cases of difficult, laryngoscopy-assisted intubation, a predefined algorithm was proposed. The Intubation Difficulty Score (IDS) was calculated for all patients requiring tracheal intubation, and factors associated with difficult intubation, defined by IDS of >5, were identified by using multivariate statistical analysis.
During the study period, 1,442 patients were included; 640 (44%) were in cardiorespiratory arrest, and 802 had a spontaneous cardiac activity. Deviation from the pharmacological and airway management procedures occurred in 1% of cases. When the predefined difficult airway management algorithm was followed, failure to intubate was encountered twice (0.1%). One hundred six (7.4%) patients had an IDS of >5, and 60 (4.1%) required first (n = 56) then second (n = 4) alternative techniques for tracheal intubation. Semirigid leaders allowed tracheal access in 93% of difficult-intubation patients. One patient required a prehospital cricothyroidotomy. Factors associated with difficult intubation were the following: a history of ear, nose, or throat neoplasia or surgery; obesity; facial trauma; the operator's status; and the operator's position.
If prehospital medical airway management is standardized and performed by trained operators, failure to intubate is rare (0.1%), and the incidence of difficult tracheal intubation is 7.4%, independent of cardiorespiratory status.
已发表的研究中，院前急救医学中困难插管的发生率差异很大，且取决于多个因素。作者的目的是确定困难插管的发生率，并确定在应用镇静和插管标准方案时与院前困难气道相关的因素。
这项为期30个月的临床、观察性、前瞻性研究由法国巴黎郊区（马恩河谷，人口130万）的一个院前急救医疗单元进行。对需要气管插管的患者的气道管理进行了标准化。对于有自主心脏活动的患者，药理学程序推荐快速顺序插管。在困难喉镜辅助插管的情况下，提出了一个预定义的算法。为所有需要气管插管的患者计算插管难度评分（IDS），并通过多变量统计分析确定与困难插管相关的因素，困难插管定义为IDS>5。
在研究期间，纳入了1442例患者；640例（44%）处于心肺骤停状态，802例有自主心脏活动。1%的病例出现了与药理学和气道管理程序的偏差。当遵循预定义的困难气道管理算法时，插管失败发生了两次（0.1%）。106例（7.4%）患者的IDS>5，60例（4.1%）患者首先（n = 56）然后第二次（n = 4）需要替代技术进行气管插管。半硬质引导器在93%的困难插管患者中实现了气管通路。1例患者需要进行院前环甲膜切开术。与困难插管相关的因素如下：耳鼻喉肿瘤或手术史；肥胖；面部创伤；操作者的状态；以及操作者的位置。
如果院前医疗气道管理标准化并由训练有素的操作者进行，插管失败很少见（0.1%），困难气管插管的发生率为7.4%，与心肺状态无关。
