Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Ann Emerg Med. 2010 Aug;56(2):83-8. doi: 10.1016/j.annemergmed.2010.01.033. Epub 2010 Mar 3.
Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can complicate laryngoscopy. We measure the difference in glottic visualization with video versus direct laryngoscopy.
We prospectively studied a convenience sample of tracheal intubations at 2 academic EDs. We performed laryngoscopy with the Karl Storz Video Macintosh Laryngoscope, which can be used for conventional direct laryngoscopy, as well as video laryngoscopy. We rated glottic visualization with the Cormack-Lehane (C-L) Scale, defining "good" visualization as C-L I or II and "poor" visualization as C-L III or IV. We compared glottic exposure between direct and video laryngoscopy, determining the proportion of poor direct visualizations improved to good visualization with video laryngoscopy. We also determined the proportion of good direct visualizations worsened to poor visualization by video laryngoscopy.
We report data on 198 patients, including 146 (74%) medical, 51 (26%) trauma, and 1 (0.51%) unknown indications. All were tracheally intubated by emergency physicians. Postgraduate year 3 or 4 residents performed 102 (52.3%) of the laryngoscopies, postgraduate year 2 residents performed 60 (30.8%), interns performed 20 (10.3%), attending physicians performed 9 (4.6%), and operator experience and specialty were not reported in 4. Overall, good visualization (C-L grade I or II) was attained in 158 direct (80%) versus 185 video laryngoscopies (93%; McNemar's P<.0001). Of the 40 patients with poor glottic exposure on direct laryngoscopy, video laryngoscopy improved the view in 31 (78%; 95% confidence interval 62% to 89%). Of the 158 patients with good glottic view on direct laryngoscopy, video laryngoscopy worsened the view in 4 (3%; 95% confidence interval 0.7% to 6%).
Video laryngoscopy affords more grade I and II views than direct laryngoscopy and improves glottic exposure in most patients with poor direct glottic visualization. In a small proportion of cases, glottic exposure is worse with video than direct laryngoscopy.
在可控手术室研究中，视频喉镜下的声门可视化优于直接喉镜。然而，在急诊科（ED）环境下，视频喉镜下的声门暴露情况尚未得到评估，在 ED 环境下，血液、分泌物、患者体位不佳和生理紊乱可能会使喉镜检查复杂化。我们测量了视频喉镜与直接喉镜在声门可视化方面的差异。
我们前瞻性研究了 2 家学术急诊科的气管插管便利样本。我们使用 Karl Storz Video Macintosh 喉镜进行喉镜检查，该喉镜可用于常规直接喉镜检查和视频喉镜检查。我们使用 Cormack-Lehane（C-L）分级来评估声门可视化情况，将“良好”的可视化定义为 C-L I 或 II，将“不良”的可视化定义为 C-L III 或 IV。我们比较了直接喉镜和视频喉镜的声门暴露情况，确定了将不良直接可视化改善为视频喉镜下良好可视化的比例。我们还确定了将良好的直接可视化恶化到视频喉镜下不良可视化的比例。
我们报告了 198 名患者的数据，其中包括 146 名（74%）内科患者、51 名（26%）创伤患者和 1 名（0.51%）未知病因患者。所有患者均由急诊医生进行气管插管。住院医师 3 或 4 年级进行了 102 次（52.3%）喉镜检查，住院医师 2 年级进行了 60 次（30.8%），住院医师进行了 20 次（10.3%），主治医生进行了 9 次（4.6%），4 名医生未报告操作经验和专业。总体而言，158 次直接喉镜检查（80%）与 185 次视频喉镜检查（93%）获得良好可视化（C-L 分级 I 或 II；McNemar's P<.0001）。在直接喉镜检查声门暴露不良的 40 名患者中，视频喉镜改善了 31 名（78%；95%置信区间 62%至 89%）。在 158 名直接喉镜检查声门良好的患者中，视频喉镜使 4 名（3%；95%置信区间 0.7%至 6%）的声门情况恶化。
视频喉镜比直接喉镜提供更多的 I 级和 II 级视图，并改善了大多数声门直接可视化不良患者的声门暴露情况。在一小部分病例中，视频喉镜下的声门暴露情况比直接喉镜更差。
