Donoghue Aaron, Ades Anne, Nishisaki Akira, Zhao Huaqing, Deutsch Ellen
Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Pediatr Emerg Care. 2013 Apr;29(4):440-6. doi: 10.1097/PEC.0b013e318289e909.
This study aimed to assess the feasibility of characterizing direct laryngoscopy (DL) and tracheal intubation (TI) technique based on videographic review and to determine the association between technical aspects of DL and TI with successful completion of intubation.
Physicians in pediatrics, emergency medicine, pediatric emergency, pediatric critical care, and neonatology performed TI on simulators (newborn, infant, and adult). A video laryngoscope was used without a display (ie, as a direct laryngoscope), and video recordings were reviewed. A scoring instrument characterized technical aspects of DL and TI; outcomes related to procedural performance were recorded. Interrater reliability of the instrument was assessed by weighted κ; collinearity was assessed by a correlation matrix. Univariate analysis determined technical aspects of DL and TI associated with outcomes.
Seventy-three subjects performed 206 intubations. Significant differences existed between simulators with respect to the first-attempt success (newborn, 63%; infant, 80%; adult, 42%; P < 0.001), laryngoscopy time (27 seconds vs 31 seconds vs 42 seconds, P < 0.001), and percentage of glottic opening score (68% vs 65% vs 35%, P < 0.001). Interrater reliability for the instrument was good (κ = 0.68); no significant collinearity existed between data points. Position of the tip of the laryngoscope blade in the vallecula and under the proximal epiglottis was associated with improved first-attempt success.
Pediatric intubation technique can be reliably assessed using videography and video laryngoscopy. Future studies should examine video-based characterization of DL and TI technique in real patients outside the operating room, as well as whether technical aspects of intubation are associated with improved outcomes.
本研究旨在评估基于视频回顾来描述直接喉镜检查（DL）和气管插管（TI）技术的可行性，并确定DL和TI的技术方面与插管成功完成之间的关联。
儿科、急诊医学、儿科急诊、儿科重症监护和新生儿科的医生在模拟器（新生儿、婴儿和成人）上进行TI操作。使用无显示屏的视频喉镜（即作为直接喉镜），并对视频记录进行回顾。一种评分工具描述了DL和TI的技术方面；记录与操作表现相关的结果。通过加权κ评估该工具的评分者间信度；通过相关矩阵评估共线性。单因素分析确定与结果相关的DL和TI的技术方面。
73名受试者进行了206次插管。不同模拟器在首次尝试成功率（新生儿，63%；婴儿，80%；成人，42%；P<0.001）、喉镜检查时间（27秒对31秒对42秒，P<0.001）和声门开口评分百分比（68%对65%对35%，P<0.001）方面存在显著差异。该工具的评分者间信度良好（κ=0.68）；数据点之间不存在显著共线性。喉镜镜片尖端位于会厌谷和会厌近端下方与首次尝试成功率提高相关。
使用摄像和视频喉镜可以可靠地评估儿科插管技术。未来的研究应检查手术室以外真实患者中基于视频的DL和TI技术特征，以及插管的技术方面是否与改善的结果相关。
