在困难气道中使用高保真模拟比较视频喉镜与直接喉镜的插管成功率

Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation.

作者信息

Narang Aneesh T, Oldeg Paula F, Medzon Ron, Mahmood Ahmed R, Spector Jordan A, Robinett Derek A

机构信息

Department of Emergency Medicine Boston Medical Center, Boston, Massachusetts 02118, USA.

出版信息

Simul Healthc. 2009 Fall;4(3):160-5. doi: 10.1097/SIH.0b013e318197d2e5.

DOI:10.1097/SIH.0b013e318197d2e5

PMID:19680083

Abstract

INTRODUCTION

A number of devices, including video laryngoscopy, are used to aid in managing difficult airways. The goal of this study was to compare timing and success of video laryngoscopy to standard laryngoscopic intubation using a simulation mannequin in normal and difficult airway scenarios.

METHODS

Residents and attending physicians of a PGY 2-4 emergency medicine residency program participated. A single, high-fidelity simulation mannequin was used. Each participant received an in-service on the video laryngoscope (GlideScope). Three airway settings were used: standard, decreased neck mobility, and tongue edema. Participants intubated with a Macintosh blade and video laryngoscope in each scenario, and graded the best view achieved using the Cormack-Lehane classification. Outcome measures included time to view the vocal cords, time to intubation, grading of view, and intubation success or failure. Institutional Review Board approval was obtained.

RESULTS

Fifty-two participants were enrolled. Participants successfully intubated the mannequin faster using the Macintosh blade in both the normal and neck immobility settings (9.4 seconds faster, 95% CI 3.2-15.7, P = 0.004, 16.1 seconds faster, 95% CI 3.6-28.7, P = 0.01). In the tongue edema setting, however, video laryngoscopy provided a better grade view of the cords, a higher success rate of viewing the cords at time of intubation (50% vs. 12%), and a higher rate of successful intubations (83% vs. 23%). The GlideScope also significantly reduced the time needed to view the cords (89 seconds reduction, 95% CI 54.4-123.7, P < 0.0001) and intubate (131.3 seconds reduction, 95% CI 99.1-163.6, P< 0.0001) for the tongue edema setting.

CONCLUSIONS

In the most difficult airway case, tongue edema, the video laryngoscope provided an enhanced view of the cords using less time, increased intubation success, and decreased the time to intubation.

摘要

引言

包括视频喉镜在内的多种设备被用于辅助处理困难气道。本研究的目的是在正常和困难气道场景下，使用模拟人体模型比较视频喉镜与标准喉镜插管的操作时间和成功率。

方法

PGY 2-4级急诊医学住院医师培训项目的住院医师和主治医师参与了研究。使用了一个单一的高保真模拟人体模型。每位参与者都接受了视频喉镜（GlideScope）的在职培训。使用了三种气道设置：标准设置、颈部活动度降低和舌部水肿。参与者在每种场景下分别使用麦金托什喉镜叶片和视频喉镜进行插管，并根据科马克-莱汉内分类法对获得的最佳视野进行分级。观察指标包括看到声带的时间、插管时间、视野分级以及插管成功或失败情况。获得了机构审查委员会的批准。

结果

共招募了52名参与者。在正常和颈部活动受限的场景中，参与者使用麦金托什喉镜叶片成功为人体模型插管的速度更快（分别快9.4秒，95%置信区间3.2-15.7，P = 0.004；快16.1秒，95%置信区间3.6-28.7，P = 0.01）。然而，在舌部水肿的场景中，视频喉镜提供了更好的声带视野分级，插管时看到声带的成功率更高（50%对12%），插管成功率也更高（83%对23%）。对于舌部水肿场景，GlideScope还显著缩短了看到声带所需的时间（减少89秒，95%置信区间54.4-123.7，P < 0.0001）和插管时间（减少131.3秒，95%置信区间99.1-163.6，P < 0.0001）。