Joshi Raj, Hypes Cameron D, Greenberg Jeremy, Snyder Linda, Malo Josh, Bloom John W, Chopra Harsharon, Sakles John C, Mosier Jarrod M
1 Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and.
2 Department of Emergency Medicine, University of Arizona, Tucson, Arizona; and.
Ann Am Thorac Soc. 2017 Mar;14(3):368-375. doi: 10.1513/AnnalsATS.201606-472OC.
Video laryngoscopy has overcome the need to align the anatomic axes to obtain a view of the glottic opening to place a tracheal tube. However, despite this advantage, a large number of attempts are unsuccessful. There are no existing data on anatomic characteristics in critically ill patients associated with a failed first attempt at laryngoscopy when using video laryngoscopy.
To identify characteristics associated with first-attempt failure at intubation when using video laryngoscopy in the intensive care unit (ICU).
This is an observational study of 906 consecutive patients intubated in the ICU with a video laryngoscope between January 2012 and January 2016 in a single-center academic medical ICU. After each intubation, the operator completed a data collection form, which included information on difficult airway characteristics, device used, and outcome of each attempt. Multivariable regression models were constructed to determine the difficult airway characteristics associated with a failed first attempt at intubation.
There were no significant differences in sex, age, reason for intubation, or device used between first-attempt failures and first-attempt successes. First-attempt successes more commonly reported no difficult airway characteristics were present (23.9%; 95% confidence interval [CI], 20.7-27.0% vs. 13.3%; 95% CI, 8.0-18.8%). In logistic regression analysis of the entire 906-patient database, blood in the airway (odds ratio [OR], 2.63; 95% CI, 1.64-4.20), airway edema (OR, 2.85; 95% CI, 1.48-5.45), and obesity (OR, 1.59; 95% CI, 1.08-2.32) were significantly associated with first-attempt failure. Data collection on limited mouth opening and secretions began after the first 133 intubations, and we fit a second logistic model to examine cases in which these additional difficult airway characteristics were collected. In this subset (n = 773), the presence of blood (OR, 2.73; 95% CI, 1.60-4.64), cervical immobility (OR, 3.34; 95% CI, 1.28-8.72), and airway edema (OR, 3.10; 95% CI, 1.42-6.70) were associated with first-attempt failure.
In this single-center study, presence of blood in the airway, airway edema, cervical immobility, and obesity are associated with higher odds of first-attempt failure, when intubation was performed with video laryngoscopy in an ICU.
视频喉镜已无需使解剖轴线对齐就能看到声门开口以放置气管导管。然而，尽管有此优势，大量尝试仍未成功。目前尚无关于在使用视频喉镜时首次喉镜检查失败的重症患者解剖特征的现有数据。
确定在重症监护病房（ICU）使用视频喉镜时首次插管失败相关的特征。
这是一项在单中心学术医疗ICU中对2012年1月至2016年1月期间906例连续使用视频喉镜在ICU进行插管的患者的观察性研究。每次插管后，操作人员填写一份数据收集表，其中包括困难气道特征、使用的设备以及每次尝试的结果等信息。构建多变量回归模型以确定与首次插管失败相关的困难气道特征。
首次尝试失败组和首次尝试成功组在性别、年龄、插管原因或使用的设备方面无显著差异。首次尝试成功组更常报告不存在困难气道特征（23.9%；95%置信区间[CI]，20.7 - 27.0%对13.3%；95% CI，8.0 - 18.8%）。在对整个906例患者数据库的逻辑回归分析中，气道内有血（比值比[OR]，2.63；95% CI，1.64 - 4.20）、气道水肿（OR，2.85；95% CI，1.48 - 5.45）和肥胖（OR，1.59；95% CI，1.08 - 2.32）与首次尝试失败显著相关。在前133例插管后开始收集关于张口受限和分泌物的资料，我们构建了第二个逻辑模型来检查收集了这些额外困难气道特征的病例。在这个亚组（n = 773）中，气道内有血（OR, 2.73；95% CI，1.60 - 4.64）、颈部活动受限（OR，3.34；95% CI，1.28 - 8.72）和气道水肿（OR，3.10；95% CI，1.42 - 6.70）与首次尝试失败相关。
在这项单中心研究中，当在ICU使用视频喉镜进行插管时，气道内有血、气道水肿、颈部活动受限和肥胖与首次尝试失败的几率较高相关。
