Limbach Tobias, Ott Thomas, Griesinger Jan, Jahn-Eimermacher Antje, Piepho Tim
Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany.
Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany.
BMC Res Notes. 2016 Feb 27;9:127. doi: 10.1186/s13104-016-1937-2.
A variety of instruments are used to perform airway management by tracheal intubation. In this study, we compared the MacIntosh balde (MB) laryngoscope with the Bonfils intubation fibrescope as intubation techniques. The aim of this study was to identify the technique (MB or Bonfils) that would allow students in their last year of medical school to perform tracheal intubation faster and with a higher success probability. Data were collected from 150 participants using an airway simulator ['Laerdal Airway Management Trainer' (Laerdal Medical AS, Stavanger, Norway)]. The participants were randomly assigned to a sequence of techniques to use. Four consecutive intubation 'trials' were performed with each technique. These trials were evaluated for differences in the following categories: the 'time to successful ventilation', 'success probability' within 90 s,'time to visualisation' of the vocal cords (glottis), and 'quality of visualisation' according to the Cormack and Lehane score (C&L, grade 1-4). The primary endpoint was the 'time to successful ventilation'in the fourth and final trial.
There was no statistically significant difference in the 'time to successful ventilation' between the two techniques in trial 4 ('time to successful ventilation': median: MB: 16 s, Bonfils: 14 s, p = 0.244). However, the 'success probability' within 90 s was higher when using a Macintosh blade than when using a Bonfils (95 vs. 87%). The glottis could be better visualised when using a Bonfils (C&L score of 1 (best view): MB: 41%, Bonfils: 93%), but visualisation was achieved more rapidly when using a Macintosh blade (median: 'time to visualisation': MB: 6 s, Bonfils: 8 s, p = 0.003).
The time to ventilation using the MacIntosh blade and Bonfils mainly did to differ, however success probabilities and time to visualisation primary favoured the MacIntosh blade as intubation technique, although the Bonfils seem to have a steeper learning curve. The Bonfils is still a promising intubation technique and might be easier to learn as the MB, at least in a manikin.
多种器械可用于通过气管插管进行气道管理。在本研究中，我们将麦金托什喉镜（MB）与邦菲尔斯插管纤维镜作为插管技术进行了比较。本研究的目的是确定哪种技术（MB或邦菲尔斯）能让医学院最后一年的学生更快地进行气管插管且成功率更高。使用气道模拟器['Laerdal气道管理训练器'（挪威斯塔万格的Laerdal Medical AS公司）]从150名参与者收集数据。参与者被随机分配使用一系列技术。每种技术进行连续4次插管“试验”。对这些试验在以下类别中的差异进行评估：“成功通气时间”、90秒内的“成功率”、声带（声门）的“可视化时间”以及根据科马克和莱哈尼评分（C&L，1 - 4级）的“可视化质量”。主要终点是第四次也是最后一次试验中的“成功通气时间”。
在试验4中，两种技术在“成功通气时间”上无统计学显著差异（“成功通气时间”：中位数：MB为16秒，邦菲尔斯为14秒，p = 0.244）。然而，使用麦金托什喉镜时90秒内的“成功率”高于使用邦菲尔斯时（95%对87%）。使用邦菲尔斯时声门能得到更好的可视化（C&L评分为1（最佳视野）：MB为41%，邦菲尔斯为93%），但使用麦金托什喉镜时可视化实现得更快（中位数：“可视化时间”：MB为6秒，邦菲尔斯为8秒，p = 0.003）。
使用麦金托什喉镜和邦菲尔斯进行通气的时间主要没有差异，然而，作为插管技术，成功率和可视化时间主要有利于麦金托什喉镜，尽管邦菲尔斯似乎学习曲线更陡。邦菲尔斯仍是一种有前景的插管技术，并且可能至少在人体模型中比麦金托什喉镜更容易学习。
