Kim Jong Won, Lee Kyeong Ryong, Hong Dae Young, Baek Kwang Je, Lee Young Hwan, Park Sang O
Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Korea.
BMJ Open. 2016 Oct 24;6(10):e011089. doi: 10.1136/bmjopen-2016-011089.
To compare the efficacy of direct laryngoscopy (DL), Pentax Airway Scope (PAWS) and GlideScope video laryngoscope (GVL) systems for endotracheal intubation (ETI) in various cervical immobilisation scenarios: manual in-line stabilisation (MILS), Philadelphia neck collar (PNC) (moderate limit of mouth opening) and Stifneck collar (SNC) (severe limit of mouth opening).
Randomised cross-over simulation study.
35 physicians who had >30 successful ETI experiences at a tertiary hospital in Seoul, Korea.
Participants performed ETI using PAWS, GVL and DL randomly in simulated MILS, PNC and SNC scenarios in our simulation centre. The end points were successful ETI and the time to complete ETI. In addition, modified Cormack-Lehane (CL) classification and pressure to teeth were recorded.
In MILS, there were no significant differences in the rate of success of ETI between the three devices: 33/35(94.3%) for DL vs 32/35(91.4%) for GVL vs 35/35(100.0%) for PAWS; p=0.230). PAWS achieved successful ETI more quickly (19.8 s) than DL (29.6 s) and GVL (35.4 s). For the PNC scenario, a higher rate of successful ETI was achieved with GVL 33/35 (94.3%) than PAWS 29/35 (82.9%) or DL 25/35 (71.4%) (p=0.040). For the SNC scenario, a higher rate of successful ETI was achieved with GVL 28/35(80.0%) than with DL 14/35(40.0%) and PAWS 7/35(20.0%) (p<0.001). For the PNC and SNC scenarios, GVL provided a relatively good view of the glottis, but a frequent pressure to teeth occurred.
All three devices are suitable for ETI in MILS. DL is not suitable in both neck collar scenarios. PAWS showed faster intubations in MILS, but was not suitable in the SNC scenario. GVL is most suitable in all cervical immobilisation scenarios, but may cause pressure to teeth more frequently.
比较直接喉镜（DL）、宾得气道镜（PAWS）和GlideScope视频喉镜（GVL）系统在各种颈椎固定情况下进行气管插管（ETI）的效果：手动直线固定（MILS）、费城颈托（PNC）（张口适度受限）和Stifneck颈托（SNC）（张口严重受限）。
随机交叉模拟研究。
韩国首尔一家三级医院中35名有超过30次成功ETI经验的医生。
参与者在我们的模拟中心，于模拟的MILS、PNC和SNC情况下，随机使用PAWS、GVL和DL进行ETI。终点指标为成功的ETI和完成ETI的时间。此外，记录改良的Cormack-Lehane（CL）分级和对牙齿的压力。
在MILS中，三种设备的ETI成功率无显著差异：DL为33/35（94.3%），GVL为32/35（91.4%），PAWS为35/35（100.0%）；p = 0.230）。PAWS完成ETI的速度（19.8秒）比DL（29.6秒）和GVL（35.4秒）更快。在PNC情况下，GVL的ETI成功率（33/35，94.3%）高于PAWS（29/35，82.9%）或DL（25/35，71.4%）（p = 0.040）。在SNC情况下，GVL的ETI成功率（28/35，80.0%）高于DL（14/35，40.0%）和PAWS（7/35，20.0%）（p < 0.001）。在PNC和SNC情况下，GVL能提供相对较好的声门视野，但对牙齿的压力频繁出现。
所有三种设备都适用于MILS中的ETI。DL在两种颈托情况下均不适用。PAWS在MILS中插管速度更快，但在SNC情况下不适用。GVL在所有颈椎固定情况下最适用，但可能更频繁地导致牙齿受压。
