视频喉镜与直接喉镜用于新生儿气管插管教学的比较：一项基于模拟的研究
Video Laryngoscopy vs. Direct Laryngoscopy in Teaching Neonatal Endotracheal Intubation: A Simulation-Based Study.
作者信息
Nair Srikumar, Thomas Eric J, Katakam Lakshmi
机构信息
Neonatology, Children's Hospital Los Angeles.
Internal Medicine, McGovern Medical School, The University of Texas Medical Health Science Center at Houston.
出版信息
Cureus. 2017 Jan 6;9(1):e962. doi: 10.7759/cureus.962.
BACKGROUND
Neonatal endotracheal intubation is a life-saving procedural skill where best practices have been developed from expert opinion. Few empirical studies have examined how this skill should be taught.
OBJECTIVE
To determine whether a video laryngoscope (VL) assisted intubation training curriculum compared to a traditional direct laryngoscope (DL) assisted curriculum improves neonatal intubation performance of novice intubators in a simulated setting.
METHODS
A randomized trial of novice intubators was conducted at the University of Texas-Houston from 6/2013-8/2013. Eligible candidates were randomly assigned to control group (DL curriculum) or intervention group (VL curriculum). Those in the intervention group received instruction with VL videos and practice with Storz C-MAC® VL (Karl Storz, Tuttlingen, Germany) in addition to a traditional curriculum. Intubation performance was evaluated in a simulated setting using a SimNewB® (Laerdal, NY, USA) manikin and traditional intubation equipment. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. The data was analyzed using Fisher's exact test and logistic regression where appropriate.
RESULTS
One hundred twenty-three trainees were enrolled, 62 (50%) in DL group and 61 (50%) in the VL group. Intubation success on first attempt was achieved by 69% (43/62) of the DL group vs. 61% (37/61) of the VL group, P=0.35. Time to successful intubation was 25 sec (interquartile range (IQR) 18, 32) in the DL group and 26.5 sec (IQR 20, 43) in the VL group, P=0.27. Those in the VL group were more likely to need more than two attempts to achieve intubation success, OR=3.09 (95% CI 1.03-9.28).
CONCLUSIONS
In a simulated setting, teaching with a VL curriculum did not improve intubation performance compared to teaching with DL. Further studies are needed to determine if VL-based teaching has an impact on clinical intubation performance.
背景
新生儿气管插管是一项挽救生命的操作技能，其最佳实践是基于专家意见制定的。很少有实证研究探讨该技能应如何教授。
目的
确定与传统直接喉镜（DL）辅助课程相比，视频喉镜（VL）辅助插管培训课程是否能在模拟环境中提高新手插管者的新生儿插管操作表现。
方法
2013年6月至8月在德克萨斯大学休斯顿分校对新手插管者进行了一项随机试验。符合条件的候选人被随机分配到对照组（DL课程）或干预组（VL课程）。干预组除接受传统课程外，还通过VL视频接受指导并使用德国卡尔·史托斯公司的Storz C-MAC®视频喉镜进行练习。使用美国Laerdal公司的SimNewB®模拟人及传统插管设备在模拟环境中评估插管操作表现。记录插管尝试次数、每次尝试的结果以及成功插管的时间。在适当情况下，使用Fisher精确检验和逻辑回归分析数据。
结果
共招募了123名学员，DL组62名（50%），VL组61名（50%）。DL组首次尝试插管成功率为69%（43/62），VL组为61%（37/61），P = 0.35。DL组成功插管时间为25秒（四分位间距（IQR）18, 32），VL组为26.5秒（IQR 20, 43），P = 0.27。VL组学员更有可能需要两次以上尝试才能成功插管，OR = 3.09（95% CI 1.03 - 9.28）。
结论
在模拟环境中，与使用DL教学相比，使用VL课程教学并未提高插管操作表现。需要进一步研究以确定基于VL的教学是否对临床插管操作表现有影响。
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