冰锥位下使用视频喉镜行气管插管：一项在模拟人体上的随机对照试验。

Tracheal intubation in the ice-pick position with video laryngoscopes: a randomised controlled trial in a manikin.

机构信息

Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany.

出版信息

Eur J Anaesthesiol. 2013 Sep;30(9):537-43. doi: 10.1097/EJA.0b013e3283614119.

DOI:10.1097/EJA.0b013e3283614119

PMID:23736089

Abstract

CONTEXT

Tracheal intubation in nonstandardised positions is associated with a higher risk of tube misplacement and may have deleterious consequences for patients. Video laryngoscopes for tracheal intubation facilitate both glottic view and success rates. However, their use in the ice-pick position has not been evaluated.

OBJECTIVE

To evaluate the role of video laryngoscopes for tracheal intubation in the ice-pick position.

DESIGN

A randomised, controlled manikin trial.

SETTING

A standardised airway manikin was placed in the corner of a room. Tracheal intubation was only possible from the lower right side of the manikin. In randomised order, participants used a standard Macintosh laryngoscope and GlideScope Ranger, Storz C-MAC, Pentax AWS, Airtraq and McGrath Series5 video laryngoscopes. Statistical analysis was performed using the Wilcoxon signed-rank and McNemar's tests; A P value of less than 0.05 was deemed statistically significant.

PARTICIPANTS

Twenty anaesthesiologists, all emergency medicine board-certified.

MAIN OUTCOME MEASURES

Time to first ventilation (primary); time to glottic view and confirmation of tube position (secondary).

RESULTS

Successful ventilation was achieved most rapidly with the Macintosh laryngoscope (36.1 ± 13.4 s; reference method), followed by the Airtraq (38.4 ± 36.3 s; P = n.s.), Pentax AWS (51.6 ± 43.3 s; P = n.s.) and Storz C-Mac (62.7 ± 49.7 s; P = n.s.). The use of the GlideScope Ranger (79.8 ± 61.9 s, P = 0.01) and McGrath series5 (79.8 ± 58.5 s, P = 0.023) resulted in significantly longer times. When comparing overall intubation success, the rate of successful tracheal intubation was higher with the Airtraq than with the McGrath Series5 (P = 0.031; all others n.s.).

CONCLUSION

The use of video laryngoscopes did not result in higher success rates or faster tracheal intubation in the ice-pick position when compared with conventional laryngoscopy in this manikin study.

TRIAL REGISTRATION

www.clinicaltrials.gov, NCT01210105.

摘要

背景

在非标准体位下进行气管插管与插管位置不当的风险增加相关，并可能对患者产生有害影响。视频喉镜有助于观察声门和提高插管成功率。然而，其在冰锥体位下的应用尚未得到评估。

目的

评估视频喉镜在冰锥体位下进行气管插管的效果。

设计

一项随机对照的模拟试验。

设置

在房间的一角放置一个标准化气道模型。仅能从模型的右下侧进行气管插管。参与者按照随机顺序使用标准的 Macintosh 喉镜和 GlideScope Ranger、STORZ C-MAC、Pentax AWS、Airtraq 和 McGrath Series5 视频喉镜。使用 Wilcoxon 符号秩和检验和 McNemar 检验进行统计分析；P 值小于 0.05 被认为具有统计学意义。

参与者

20 名麻醉科医生，均为急诊医学委员会认证医师。

主要观察指标

首次通气时间（主要指标）；观察到声门视图和确认导管位置的时间（次要指标）。

结果

使用 Macintosh 喉镜最快实现了有效的通气（36.1 ± 13.4 s；参考方法），其次是 Airtraq（38.4 ± 36.3 s；P = n.s.）、Pentax AWS（51.6 ± 43.3 s；P = n.s.）和 Storz C-MAC（62.7 ± 49.7 s；P = n.s.）。使用 GlideScope Ranger（79.8 ± 61.9 s，P = 0.01）和 McGrath series5（79.8 ± 58.5 s，P = 0.023）导致的时间明显延长。在比较总体插管成功率时，Airtraq 的气管插管成功率高于 McGrath Series5（P = 0.031；其他所有喉镜均为 n.s.）。