Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Murdoch, Western Australia.
School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia.
Anaesthesia. 2017 Jul;72(7):835-839. doi: 10.1111/anae.13837. Epub 2017 Mar 24.
An accurate and reproducible recording of laryngoscopic view at tracheal intubation is an important aspect of anaesthetic practice. Unlike direct laryngoscopy, in which the view achieved by the line of sight directly relates to the ease of intubating the trachea, videolaryngoscopy can create a situation in which the view is good, but intubation difficult or impossible. Communicating this to a subsequent anaesthetist is important. We compared three scoring systems: Cormack and Lehane; POGO (percentage of glottic opening); and the Fremantle score, as used by 74 critical care doctors rating 30 anonymised videos of videolaryngoscopic intubations. Accuracy (degree of agreement of score with an expert panel assessment) was higher for POGO (75.5%) and the Fremantle score (73.9%) than for Cormack and Lehane (65.4%; p < 0.001). Intra-rater reliability (mean free marginal Kappa for ordinal scores and mean Cronbach's Alpha for continuous score) was higher for Fremantle score (0.796) and Cormack and Lehane (0.773) than POGO (0.693). Inter-rater reliability for Fremantle score (0.618) and POGO (0.614) were similar and higher than the inter-rater reliability of Cormack and Lehane 0.464 (p < 0.001). The higher accuracy and inter-rater reliability of POGO and the Fremantle score suggest they are preferable to Cormack and Lehane for use when documenting videolaryngoscopy. The additional information about ease of intubation conveyed by the Fremantle score may support its routine use in recording videolaryngoscopic intubation.
在气管插管中准确且可重现的喉镜视图记录是麻醉实践的一个重要方面。与直接喉镜不同，直接喉镜通过视线直接获得的视图与气管插管的难易程度直接相关，而视频喉镜可能会造成一种情况，即视图良好，但插管困难或不可能。将此情况传达给后续的麻醉师很重要。我们比较了三种评分系统：Cormack 和 Lehane；POGO（声门张开的百分比）；以及 Fremantle 评分，由 74 名重症监护医生对 30 个匿名视频进行评分。与 Cormack 和 Lehane（65.4％；p <0.001）相比，POGO（75.5％）和 Fremantle 评分（73.9％）的准确性（评分与专家小组评估的一致性程度）更高。Fremantle 评分（0.796）和 Cormack 和 Lehane（0.773）的内部评分者可靠性（有序评分的平均自由边际 Kappa 和连续评分的平均 Cronbach's Alpha）均高于 POGO（0.693）。Fremantle 评分（0.618）和 POGO（0.614）的评分者间可靠性相似，高于 Cormack 和 Lehane 的评分者间可靠性（0.464；p <0.001）。POGO 和 Fremantle 评分的准确性和评分者间可靠性较高，表明在记录视频喉镜时，它们优于 Cormack 和 Lehane。Fremantle 评分提供的有关插管难易程度的额外信息可能支持其在记录视频喉镜插管中的常规使用。
