Whatcom Medic One, Bellingham, Washington 98225, USA.
Prehosp Emerg Care. 2010 Apr-Jun;14(2):278-82. doi: 10.3109/10903120903537189.
Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills of the intubator. Unfortunately, the limited number of outcome studies adds to the controversy. New technology, the video laryngoscope, has been introduced to facilitate tracheal intubation. At least one model of video laryngoscope (GlideScope Ranger) has been designed for out-of-hospital use. In an effort to assess the effect this technology might have on out-of-hospital intubation, a study comparing traditional laryngoscopy (TL) versus video laryngoscopy (VL) was performed. The study endpoint was the number of attempts to achieve intubation. Data were also collected on time to intubate, nonventilated periods, unrecognized misplaced tubes, and complications of the procedure.
Data were collected on 300 consecutive patients, 6 years of age or older, weighing at least 20 kg, who were intubated using TL. They were compared with data on 315 patients who were intubated using VL. All intubations were confirmed by visualization where possible, auscultation, misting, and capnography. In addition, all were continuously monitored by capnography.
The average time to intubate in the VL group was 21 seconds (range 8-43 seconds) versus 42 seconds (range 28-90 seconds) in the TL group. The average number of attempts was 1.2 (range 1-3) in the VL group versus 2.3 (range 1-4) in the TL group. Successful intubation was 97% in the VL group versus 95% in the TL group. There were no unrecognized misplaced tubes in either group. For failed intubations, an alternative airway was successful in 99% of the VL group and 99% of the TL group. Maximum nonventilated time during any one intubation attempt was 37 seconds in the VL group and 55 seconds in the TL group.
The numbers of attempts were significantly reduced in the VL group. This suggests that the use of VL has a positive effect on the number of attempts to achieve tracheal intubation.
院外气管插管存在争议，因为其安全性以及对患者护理的影响存在问题。导致争议的因素包括插管失败、所需尝试次数、通气中断时间过长以及气管插管位置不当。然而，最重要的因素是插管者的决策和临床技能。不幸的是，有限的研究结果数量加剧了争议。新技术，视频喉镜，已被引入以促进气管插管。至少有一种视频喉镜（GlideScope Ranger）专为院外使用而设计。为了评估这项技术对院外插管可能产生的影响，进行了一项比较传统喉镜（TL）与视频喉镜（VL）的研究。研究终点是插管尝试的次数。还收集了插管时间、通气中断时间、未识别的位置不当的气管插管以及操作并发症的数据。
收集了 300 例连续患者的数据，年龄 6 岁或以上，体重至少 20 公斤，使用 TL 进行插管。将其与使用 VL 插管的 315 例患者的数据进行比较。所有插管均尽可能通过可视化、听诊、喷雾和 capnography 确认。此外，所有插管均通过 capnography 进行连续监测。
VL 组的平均插管时间为 21 秒（范围 8-43 秒），TL 组为 42 秒（范围 28-90 秒）。VL 组的平均尝试次数为 1.2（范围 1-3），TL 组为 2.3（范围 1-4）。VL 组的插管成功率为 97%，TL 组为 95%。两组均无未识别的位置不当的气管插管。对于插管失败，VL 组和 TL 组的替代气道均有 99%成功。VL 组在任何一次插管尝试中最长的无通气时间为 37 秒，TL 组为 55 秒。
VL 组的尝试次数明显减少。这表明 VL 的使用对实现气管插管的尝试次数有积极影响。
