Sakles John C, Mosier Jarrod M, Chiu Stephen, Keim Samuel M
Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA.
J Emerg Med. 2012 Apr;42(4):400-5. doi: 10.1016/j.jemermed.2011.05.019. Epub 2011 Jul 14.
Video laryngoscopy has, in recent years, become more available to emergency physicians. However, little research has been conducted to compare their success to conventional direct laryngoscopy.
To compare the success rates of GlideScope(®) (Verathon Inc., Bothell, WA) videolaryngoscopy (GVL) with direct laryngoscopy (DL) for emergency department (ED) intubations.
This was a 24-month retrospective observational study of all patients intubated in a single academic ED with a level I trauma center. Structured data forms were completed after each intubation and entered into a continuous quality improvement database. All patients intubated in the ED with either the GlideScope(®) standard, Cobalt, Ranger, or traditional Macintosh or Miller laryngoscopes were included. All patients intubated before arrival were excluded. Primary analysis evaluated overall and first-attempt success rates, operator experience level, performance characteristics of GVL, complications, and reasons for failure.
There were 943 patients intubated during the study period; 120 were excluded due to alternative management strategies. DL was used in 583 (62%) patients, and GVL in 360 (38%). GVL had higher first-attempt success (75%, p = 0.03); DL had a higher success rate when more than one attempt was required (57%, p = 0.003). The devices had statistically equivalent overall success rates. GVL had fewer esophageal intubations (n = 1) than DL (n = 18); p = 0.005.
The two techniques performed equivalently overall, however, GVL had a higher overall success rate, and lower number of esophageal complications. In the setting of ED intubations, GVL offers an excellent option to maximize first-attempt success for airway management.
近年来，视频喉镜已越来越多地为急诊医生所用。然而，很少有研究将其成功率与传统直接喉镜检查进行比较。
比较GlideScope（®）（美国华盛顿州博塞尔市Verathon公司）视频喉镜检查（GVL）与直接喉镜检查（DL）用于急诊科（ED）插管的成功率。
这是一项为期24个月的回顾性观察研究，研究对象为在一家设有一级创伤中心的单一学术性急诊科接受插管的所有患者。每次插管后填写结构化数据表格，并录入持续质量改进数据库。所有在急诊部使用GlideScope（®）标准型、钴型、巡林者型或传统Macintosh或Miller喉镜进行插管的患者均纳入研究。所有在到达之前已插管的患者被排除。主要分析评估总体成功率和首次尝试成功率、操作者经验水平、GVL的性能特点、并发症以及失败原因。
研究期间共有943例患者接受插管；120例因采用替代管理策略而被排除。583例（62%）患者使用了DL，360例（38%）患者使用了GVL。GVL首次尝试成功率更高（75%，p = 0.03）；当需要多次尝试时，DL的成功率更高（57%，p = 0.003）。两种设备的总体成功率在统计学上相当。GVL的食管插管（n = 1）比DL（n = 18）少；p = 0.005。
两种技术总体表现相当，然而，GVL的总体成功率更高，食管并发症数量更少。在急诊部插管的情况下，GVL为气道管理实现首次尝试成功最大化提供了一个极佳选择。
