简化气道风险指数与常规气道评估对意外困难气管插管影响的研究 - 一项涉及 64273 名参与者的集群随机试验。

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants.

机构信息

Department of Anaesthesiology, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 3400, Denmark Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark.

出版信息

Br J Anaesth. 2016 May;116(5):680-9. doi: 10.1093/bja/aew057.

DOI:10.1093/bja/aew057

PMID:27106972

Abstract

BACKGROUND

Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.

METHODS

From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.

RESULTS

A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).

CONCLUSIONS

Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.

CLINICAL TRIAL REGISTRATION

NCT01718561.

摘要

背景

未预料到的困难插管仍然是麻醉中的一个挑战。简化气道风险指数（SARI）是一个多变量风险模型，包含 7 个独立的插管困难危险因素。我们的目的是比较基于 SARI 的术前气道评估与常规气道评估。

方法

从 2012 年 10 月 1 日至 2013 年 12 月 31 日，28 个科室被整群随机分为应用 SARI 模型或常规气道评估的两组。SARI 组实施 SARI 模型。非 SARI 组继续进行常规气道评估，因此反映了一组麻醉师不同的个体气道评估。两组均在丹麦麻醉数据库中登记了术前预测的困难插管和实际插管困难。术前计划采用先进技术（如视频喉镜；灵活的光镜）进行插管的患者被排除在主要分析之外。主要结局是意外困难和意外容易插管的比例。

结果

共纳入 26 个科室（15 个 SARI 和 11 个非 SARI）和 64273 名患者。在主要分析中，纳入了 29209 名 SARI 患者和 30305 名非 SARI 患者。在 SARI 组中，2.4%（696 名）的患者发生意外困难插管，而非 SARI 组为 2.4%（723 名）。设计变量调整后的比值比（OR）为 1.03（95%CI：0.77-1.38）。SARI 组中意外容易插管的比例为 1.42%（415 名），而非 SARI 组为 1.00%（302 名）。调整后的 OR 为 1.26（0.68-2.34）。