Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA
Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA.
Br J Anaesth. 2015 Feb;114(2):290-6. doi: 10.1093/bja/aeu370. Epub 2014 Nov 5.
We hypothesized that the time to successful fibreoptic tracheal intubation through the nasal route would be faster than the oral route for both experts and trainees in children <2 yr of age.
One hundred children, 24 months and under in age, were randomized to an operator (expert or trainee), and route (nasal or oral) for fibreoptic tracheal intubation. Three separate times were then measured: (i) time to first glottic view, (ii) time to carinal view, and (iii) total time to successful tracheal intubation. The number of attempts made, manoeuvres needed to obtain an adequate laryngeal view, and manoeuvres for tracheal tube passage were also recorded.
Time to successful tracheal intubation was significantly faster for experts than trainees. There was no difference in the time to tracheal intubation between the nasal and oral routes for experts. In trainees, intubation times were shorter for the nasal route-median (inter-quartile range) time (s) to carinal view was 35 (27-63) for the nasal route vs 59 (38-94) for the oral route (P=0.03), and the median time to successful tracheal intubation were 62 (49-122) vs 117 (61-224), P=0.05, for the nasal and oral routes, respectively. For trainees, the oral route required a greater number of airway manoeuvres for adequate laryngeal views and passage of the tracheal tube compared with the nasal route.
For clinicians with less experience in using paediatric bronchoscopes, fibreoptic tracheal intubation through the nasal route may be a more straightforward process than the oral route in children <2 yr of age.
NCT02029300 (www.clinicaltrials.gov).
我们假设，在 24 个月以下的儿童中，专家和学员经鼻途径行纤维光导气管插管的成功时间都快于经口途径。
100 名年龄在 24 个月及以下的儿童，随机分为操作者（专家或学员）和插管途径（经鼻或经口）。然后分别测量三个时间：（i）首次见到声门的时间，（ii）见到隆嵴的时间，（iii）成功气管插管的总时间。还记录了尝试的次数、获得足够的喉部视野所需的操作以及气管导管通过的操作。
专家行气管插管的成功时间明显快于学员。对于专家来说，经鼻途径与经口途径的气管插管时间无差异。对于学员，经鼻途径的插管时间更短（中位数（四分位间距）秒）：见到隆嵴的时间为 35（27-63），经口途径为 59（38-94）（P=0.03）；成功气管插管的中位时间分别为 62（49-122）和 117（61-224）（P=0.05），经鼻和经口途径。对于学员，与经鼻途径相比，经口途径需要更多的气道操作才能获得足够的喉部视野和气管导管通过。
对于使用小儿支气管镜经验较少的临床医生来说，在 24 个月以下的儿童中，经鼻途径行纤维光导气管插管可能比经口途径更简单。
NCT02029300（www.clinicaltrials.gov）。
