Stephens Christopher T, Kahntroff Stephanie, Dutton Richard P
Division of Trauma Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Anesth Analg. 2009 Sep;109(3):866-72. doi: 10.1213/ane.0b013e3181ad87b0.
Emergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission.
We examined Trauma Registry, quality management, and billing system records from July 1996 to June 2006 to determine the number of patients requiring intubation within 1 h of hospital arrival and to estimate the number requiring intubation with the first 24 h. We reviewed the medical record of each patient in either cohort who underwent a surgical airway access procedure (tracheotomy or cricothyrotomy) to determine the presenting characteristics of the patients and the reason they could not be orally or nasally intubated.
All intubation attempts were supervised by an anesthesiologist experienced in trauma patient care. Rapid sequence intubation with direct laryngoscopy was the standard approach throughout the study period. During the first hour after admission, 6088 patients required intubation, of whom 21 (0.3%) received a surgical airway. During the first 24 h, 10 more patients, for a total of 31, received a surgical airway, during approximately 32,000 attempts (0.1%). Unanticipated difficult upper airway anatomy was the leading reason for a surgical airway. Four of the 31 patients died of their injuries but none as the result of failed intubation.
In the hands of experienced anesthesiologists, rapid sequence intubation followed by direct laryngoscopy is a remarkably effective approach to emergency airway management. An algorithm designed around this approach can achieve very high levels of success.
紧急气道管理是许多麻醉医生必须掌握的技能。我们研究了一家一级创伤中心10年的经验，以确定入院后24小时内气管插管尝试的结果。
我们检查了1996年7月至2006年6月的创伤登记、质量管理和计费系统记录，以确定入院后1小时内需要插管的患者数量，并估计在最初24小时内需要插管的患者数量。我们回顾了每组中接受手术气道通路手术（气管切开术或环甲膜切开术）的每位患者的病历，以确定患者的临床表现以及无法经口或经鼻插管的原因。
所有插管尝试均由一位在创伤患者护理方面经验丰富的麻醉医生监督。在整个研究期间，直接喉镜下快速顺序插管是标准方法。入院后第一小时内，6088名患者需要插管，其中21名（0.3%）接受了手术气道。在最初24小时内，又有10名患者，总共31名患者，在约32000次尝试中接受了手术气道（0.1%）。意外的上气道解剖结构困难是手术气道的主要原因。31名患者中有4名因伤死亡，但无一例死于插管失败。
在经验丰富的麻醉医生手中，直接喉镜下快速顺序插管是一种非常有效的紧急气道管理方法。围绕这种方法设计的算法可以取得非常高的成功率。
