Aberle Sara J, Sandefur Benjamin J, Sunga Kharmene L, Campbell Ronna L, Lohse Christine M, Alecastro Puls Henrique, Laudon Sarah, Sztajnkrycer Matthew D
1Department of Emergency Medicine,Mayo Clinic,Rochester,MinnesotaUSA.
2Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,MinnesotaUSA.
Prehosp Disaster Med. 2015 Jun;30(3):259-63. doi: 10.1017/S1049023X15004707. Epub 2015 May 11.
Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE.
Post-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities.
Twenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario.
The time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.
在去污通道中对受污染患者进行管理需要使用危险材料（HazMat）个人防护装备（PPE）。先前的研究表明，HazMat PPE可能会增加气道管理的难度。本研究比较了在佩戴HazMat PPE进行气管插管（ETI）期间视频喉镜（VL）与传统直接喉镜（DL）的效率。
将1 - 3年级的急诊医学住院医师随机分为VL组或DL组，同时佩戴密封式PPE。使用GlideScope Cobalt AVL视频喉镜进行视频喉镜检查。主要结局指标是在高保真模拟人体模型中成功进行ETI的时间。分析中使用了三个时间点：时间0（喉镜叶片位于嘴唇处）、时间1（气管导管置入后喉镜叶片从嘴唇处移除）和时间2（将袋阀面罩[BVM]连接到气管导管）。次要结局指标是对VL和DL ETI方式的易用性和可行性的感知。
23名符合条件的住院医师中有21名（91.3%）参与。DL组ETI的平均时间为10.0秒（标准差=5.3秒），VL组为7.8秒（标准差=3.0秒）（P = 0.081）。从插入喉镜叶片到连接BVM的平均时间分别为17.4秒（标准差=6.0秒）和15.6秒（标准差=4.6秒）（P = 0.30）。没有插管失败的尝试。20名参与者中有17名（85.0%）认为在佩戴PPE进行ETI时VL更易于使用。20名参与者中有12名（60%）认为在实际的HazMat场景中DL更可行。
VL和DL成功进行ETI的时间没有显著差异。视频喉镜的易用性更高，但在实际的HazMat情况下，DL被认为更可行。这些发现表明，DL和VL都是在HazMat情况下使用的合理方式，方式的选择可以基于临床情况和提供者的经验。
