Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
Anesth Analg. 2011 Oct;113(4):791-800. doi: 10.1213/ANE.0b013e3182288bda. Epub 2011 Sep 2.
The AP Advance (APA) is a videolaryngoscope with interchangeable blades: intubators can choose standard Macintosh blades or a difficult-airway blade with increased curvature and a channel to guide the tube to the larynx. The APA may therefore be comparably effective in both normal and difficult airways. We tested the hypotheses that intubation with the APA is no slower than Macintosh laryngoscopy for normal mannequin airways, and that it is no slower than videolaryngoscopy using a GlideScope Ranger in difficult mannequin airways.
Medical professionals whose roles potentially include tracheal intubation were trained with each device. Participants intubated simulated (Laerdal SimMan) normal and difficult airways with the APA, GlideScope, and a conventional Macintosh blade. Speed of intubation was compared using Cox proportional hazards regression, with a hazard ratio >0.8 considered noninferior. We also compared laryngeal visualization, failures, and participant preferences.
Unadjusted intubation times in the normal airway with the APA and Macintosh were virtually identical (median, 22 vs 23 seconds); after adjustment for effects of experience, order, and period, the hazard ratio (95% confidence interval) comparing APA with Macintosh laryngoscopy was 0.87 (0.65, 1.17), which was not significantly more than our predefined noninferiority boundary of 0.8 (P = 0.26). Intubation with the APA was faster than with the GlideScope in difficult airways (hazard ratio = 7.6 [5.0, 11.3], P < 0.001; median, 20 vs 59 seconds). All participants intubated the difficult airway mannequin with the APA, whereas 33% and 37% failed with the GlideScope and Macintosh, respectively. In the difficult airway, 99% of participants achieved a Cormack and Lehane grade I to II view with the APA, versus 85% and 33% with the GlideScope and Macintosh, respectively. When asked to choose 1 device overall, 82% chose the APA.
Intubation times were similar with the APA and Macintosh laryngoscopes in mannequins with normal airways. However, intubation with the APA was significantly faster than with the GlideScope in the difficult mannequin simulation.
AP advance（APA）是一种带有可互换叶片的视频喉镜：插管者可以选择标准的 Macintosh 叶片或具有更大曲率和引导管进入喉部通道的困难气道叶片。因此，APA 在正常和困难气道中可能同样有效。我们检验了以下假设：对于正常的人工气道，使用 APA 进行插管的速度不比 Macintosh 喉镜慢，并且在困难的人工气道中，它的速度不比使用 GlideScope Ranger 的视频喉镜慢。
我们对可能包括气管插管的角色的医疗专业人员进行了每种设备的培训。参与者使用 APA、GlideScope 和常规的 Macintosh 叶片对模拟（Laerdal SimMan）正常和困难的气道进行插管。使用 Cox 比例风险回归比较插管速度，危险比（HR）>0.8 被认为是非劣效性。我们还比较了喉部可视化、失败和参与者的偏好。
在正常气道中，使用 APA 和 Macintosh 进行插管的时间几乎相同（中位数分别为 22 秒和 23 秒）；在调整经验、顺序和时期的影响后，APA 与 Macintosh 喉镜比较的 HR（95%置信区间）为 0.87（0.65，1.17），这并不显著超过我们预先设定的非劣效性边界 0.8（P=0.26）。在困难气道中，使用 APA 进行插管的速度比使用 GlideScope 快（HR=7.6[5.0，11.3]，P<0.001；中位数分别为 20 秒和 59 秒）。所有参与者均能使用 APA 对困难气道模型进行插管，而使用 GlideScope 和 Macintosh 进行插管的失败率分别为 33%和 37%。在困难气道中，99%的参与者使用 APA 获得了 Cormack 和 Lehane Ⅰ至Ⅱ级视图，而使用 GlideScope 和 Macintosh 的分别为 85%和 33%。当被要求总体选择 1 种设备时，82%的参与者选择了 APA。
在正常气道模型中，使用 APA 和 Macintosh 喉镜的插管时间相似。然而，在困难的人工气道模拟中，使用 APA 进行插管的速度明显快于使用 GlideScope。
