6 种可视喉镜在 720 例模拟困难气道患者中的评估：一项多中心随机对照试验。
Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial.
机构信息
Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern and University of Bern, Switzerland Department of Anaesthesia and Intensive Care, Barts Heart Centre, London, UK
Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern and University of Bern, Switzerland.
出版信息
Br J Anaesth. 2016 May;116(5):670-9. doi: 10.1093/bja/aew058.
BACKGROUND
Videolaryngoscopes are aggressively marketed, but independent evaluation in difficult airways is scarce. This multicentre, prospective randomized controlled trial evaluates six videolaryngoscopes in patients with a simulated difficult airway.
METHODS
With ethics committee approval and written informed consent, 12 senior anaesthetists intubated the trachea of 720 patients. A cervical collar limited mouth opening and neck movement, making intubation difficult. We evaluated three unchannelled (C-MAC™ D-blade, GlideScope™, and McGrath™) and three channelled videolaryngoscopes (Airtraq™, A.P. Advance™ difficult airway blade, and KingVision™). The primary outcome was first-attempt intubation success rate. Secondary outcomes included overall success rate, laryngeal view, intubation times, and side-effects. The primary hypothesis for every videolaryngoscope was that the 95% confidence interval of first-attempt success rate is ≥90%.
RESULTS
Mouth opening was decreased from 46 (sd 7) to 23 (3) mm with the cervical collar. First-attempt success rates were 98% (McGrath™), 95% (C-MAC™ D-blade), 87% (KingVision™), 85% (GlideScope™ and Airtraq™), and 37% (A.P. Advance™, P<0.01). The 95% confidence interval of first-attempt success rate was >90% only for the McGrath™. Overall success, laryngeal view, and intubation times differed significantly between videolaryngoscopes (all P<0.01). Side-effects were minor.
CONCLUSIONS
This trial revealed differences in the performance of six videolaryngoscopes in 720 patients with restricted neck movement and limited mouth opening. In this setting, first-attempt success rates were 85-98%, except for the A.P. Advance™ difficult airway blade. Highest success and lowest tissue trauma rates were achieved by the McGrath™ and C-MAC™ D-blade, highlighting the importance of the videolaryngoscope blade design.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov: identifier NCT01692535.
背景
视频喉镜被大力推广，但在困难气道中独立评估的资料却很少。本项多中心前瞻性随机对照试验评估了 6 种视频喉镜在模拟困难气道患者中的应用。
方法
在获得伦理委员会批准和书面知情同意后，12 位资深麻醉医生为 720 名患者进行了气管插管。颈托限制了口张开度和颈部运动，使插管变得困难。我们评估了 3 种无通道（C-MAC™ D 刀片、GlideScope™ 和 McGrath™）和 3 种有通道视频喉镜（Airtraq™、A.P. Advance™ 困难气道刀片和 KingVision™）。主要结局是首次尝试插管成功率。次要结局包括总体成功率、喉镜视野、插管时间和不良反应。每种视频喉镜的主要假设是，首次尝试成功率的 95%置信区间≥90%。
结果
颈托使用后口张开度从 46（标准差 7）减少至 23（3）mm。首次尝试成功率分别为 98%（McGrath™）、95%（C-MAC™ D 刀片）、87%（KingVision™）、85%（GlideScope™和 Airtraq™）和 37%（A.P. Advance™，P<0.01）。只有 McGrath™的首次尝试成功率 95%置信区间>90%。总体成功率、喉镜视野和插管时间在不同视频喉镜之间差异显著（均 P<0.01）。不良反应轻微。
结论
本试验揭示了在颈部运动受限和口张开度有限的 720 名患者中，6 种视频喉镜的性能存在差异。在此情况下，首次尝试成功率为 85-98%，除 A.P. Advance™ 困难气道刀片外。McGrath™和 C-MAC™ D 刀片的成功率和最低组织创伤率最高，这突出了视频喉镜刀片设计的重要性。
临床试验注册
ClinicalTrials.gov：标识符 NCT01692535。
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