Turner Joseph S, Ellender Timothy J, Okonkwo Enola R, Stepsis Tyler M, Stevens Andrew C, Sembroski Erik G, Eddy Christopher S, Perkins Anthony J, Cooper Dylan D
Indiana University School of Medicine, Department of Emergency Medicine, United States.
Indiana University School of Medicine, Department of Emergency Medicine, United States; Carolinas Medical Center Emergency Medicine Residency, United States.
Am J Emerg Med. 2017 Jul;35(7):986-992. doi: 10.1016/j.ajem.2017.02.011. Epub 2017 Feb 5.
Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions.
This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and espiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0-10° (supine), 11-44° (inclined), and ≥45° (upright); first past success was also analyzed in 5 degree angle increments.
A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p=0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR=1.11; 95% CI=1.01-1.22, p=0.043).
In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted.
气管插管术的教学与操作大多是在仰卧位进行。近期文献表明，将患者头部抬高至更直立的位置可能会减少插管期间的并发症。然而，关于急诊科直立位插管可行性的数据很少。本研究的目的是测定急诊医学住院医师在仰卧位和非仰卧位（包括直立位）进行插管的成功率。
这是一项前瞻性观察研究。进行插管的住院医师记录床头的角度。成功插管所需的尝试次数由教员和呼吸治疗师记录。首次通过成功的主要结果是针对三组计算的：0-10°（仰卧位）、11-44°（倾斜位）和≥45°（直立位）；首次通过成功也以5度角增量进行分析。
共分析了58名住院医师进行的231次插管。仰卧位组首次通过成功率为65.8%，倾斜位组为77.9%，直立位组为85.6%（p=0.024）。角度每增加5度，首次通过成功的可能性就增加（比值比=1.11；95%置信区间=1.01-1.22，p=0.043）。
在我们的研究中，急诊医学住院医师在直立位插管成功率很高。虽然这并未证明因果关系，但它与近期挑战传统仰卧位插管方法的文献相关，并表明有必要进一步研究急诊科插管期间的最佳体位。
