Shah Kaushal H, Kwong Brian M, Hazan Alberto, Newman David H, Wiener Dan
Department of Emergency Medicine, St. Luke's/Roosevelt Hospital Center, Columbia University, New York, NY, USA.
J Emerg Med. 2011 Jan;40(1):1-6. doi: 10.1016/j.jemermed.2008.04.045. Epub 2008 Nov 8.
The gum elastic bougie (GEB) is a rescue airway device commonly found in the emergency department (ED). However, data documenting its efficacy are lacking in the emergency medicine literature.
To determine the success rate of endotracheal intubation using a GEB and the reliability of "palpable clicks" and "hold-up" in the ED setting.
The GEB was introduced at our two affiliated urban EDs with a 3-year residency training program and an annual census of 150,000. Physicians were trained in the use of the GEB before initiation of the study. Over the course of 1 year, we conducted a prospective, observational study of GEB practices in the ED. The study population included all adult patients on whom intubation was attempted with a GEB. All emergency physicians attempting intubation completed a structured data form after laryngoscopy, recording patient characteristics, grade of laryngeal view (using the modified Cormack-Lehane classification), and presence of "palpable clicks" and "hold-up." Indications for GEB use in our ED include a difficult or rescue airway and for training purposes. Data were analyzed using standard statistical methods and 95% confidence intervals.
In our study period, there were 26 patients on whom intubation was attempted with a GEB. The overall success rate was 20/26 (76.9%; 95% confidence interval [CI] 60.7-93.1%). Among cases where the GEB was used for training purposes (all grade 1 or 2a laryngeal view), six of seven (85.7%) intubations were successful. When the GEB was used for clinically indicated purposes, 14 of 19 (73.7%; 95% CI 53.9-93.5%) intubations were successful. Palpable clicks were appreciated in 11/20 successful intubations (sensitivity 55.0%; 95% CI 33.2-76.8%); there was one false positive (specificity 80%; 95% CI 40.9-98.2%). Of 20 successful intubations, hold-up was deferred in five cases; of 15 remaining cases, hold-up was appreciated in 5/15 (sensitivity 33.3%; 95% CI 9.5-57.2%); there were no false positives (specificity 100%; 95% CI 60.7-100%).
In our ED setting, the GEB had a success rate of 73.7% when utilized as a rescue airway after failed attempts. The characteristics of "palpable clicks" and "hold-up" were unreliable.
弹性橡胶探条（GEB）是急诊科常见的一种急救气道装置。然而，急诊医学文献中缺乏记录其有效性的数据。
确定在急诊科环境中使用GEB进行气管插管的成功率以及“可触及喀哒声”和“受阻”的可靠性。
在我们两家附属的城市急诊科引入了GEB，这两家急诊科设有为期3年的住院医师培训项目，年接诊量为15万。在研究开始前，医生们接受了GEB使用培训。在1年的时间里，我们对急诊科GEB的使用情况进行了一项前瞻性观察研究。研究人群包括所有尝试使用GEB进行插管的成年患者。所有尝试插管的急诊医生在喉镜检查后填写一份结构化数据表格，记录患者特征、喉镜视野分级（使用改良的Cormack-Lehane分类法）以及“可触及喀哒声”和“受阻”的情况。在我们急诊科使用GEB的指征包括困难气道或急救气道以及用于培训目的。使用标准统计方法和95%置信区间对数据进行分析。
在我们的研究期间，有26例患者尝试使用GEB进行插管。总体成功率为20/26（76.9%；95%置信区间[CI]60.7 - 93.1%）。在将GEB用于培训目的的病例中（所有喉镜视野为1级或2a级），7例中有6例（85.7%）插管成功。当GEB用于临床指征明确的目的时，19例中有14例（73.7%；95%CI 53.9 - 93.5%）插管成功。在20例成功插管中，11例可触及喀哒声（敏感性55.0%；95%CI 33.2 - 76.8%）；有1例假阳性（特异性80%；95%CI 40.9 - 98.2%）。在20例成功插管中，5例延迟出现受阻情况；在其余15例中，15例中有5例出现受阻情况（敏感性33.3%；95%CI 9.5 - 57.2%）；无假阳性（特异性100%；95%CI 60.7 - 100%）。
在我们的急诊科环境中，GEB作为失败尝试后的急救气道使用时成功率为73.7%。 “可触及喀哒声”和“受阻”的特征不可靠。
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