Stein Christopher, Gerber Louis, Curtin Denis, Oberem Nicole, Wells Mike
Department of Emergency Medical Care, Faculty of Health Sciences,University of Johannesburg,Johannesburg,South Africa.
Prehosp Disaster Med. 2017 Aug;32(4):419-423. doi: 10.1017/S1049023X17006392. Epub 2017 Apr 6.
Aim The goal of this study was to compare the relative effectiveness of three adjunctive maneuvers - head elevation (HE), forward laryngoscope traction (FT), and external laryngeal manipulation (ELM) - on laryngoscopic view, intubation time, and intubation success performed by a sample of novice intubators using a simulated airway.
Twenty-two second year university paramedic students were required to perform laryngoscopy and intubation on a simulator four times on two separate days. The first day involved intubation using no adjunctive maneuvers (control) plus HE, FT, and ELM in random order in a normal simulated airway. A similar approach was used on the second day, but the simulator was configured to have a difficult airway. Percentage of glottic opening (POGO) scores, intubation time, and intubation success were measured for all intubation attempts.
Head elevation was found to be the most effective adjunctive maneuver in the normal airway, increasing the mean POGO score from control by 27% (P=.002), while ELM was most effective in the difficult airway, increasing the mean POGO score by 21% (P=.009) and the proportion of successful intubations by 41% (P<.001). All maneuvers decreased intubation time in the normal and difficult airway and were associated with significant differences in intubation success compared to control in the difficult airway.
This study identified HE as the most effective maneuver for improving laryngoscopic view in a normal airway and ELM as the most effective in a difficult airway in a group of novice intubators. Stein C , Gerber L , Curtin D , Oberem N , Wells M . A comparison of three maneuvers and their effect on laryngoscopic view, time to intubate, and intubation outcome by novice intubators in a simulated airway. Prehosp Disaster Med. 2017;32(4):419-423.
目的 本研究的目的是比较三种辅助操作——头部抬高（HE）、喉镜向前牵引（FT）和外部喉部操作（ELM）——对新手插管者使用模拟气道进行喉镜视野、插管时间和插管成功率的相对有效性。
22名大学二年级护理专业学生被要求在两个不同的日子里在模拟器上进行四次喉镜检查和插管操作。第一天在正常模拟气道中按随机顺序进行不使用辅助操作（对照）加HE、FT和ELM的插管。第二天采用类似方法，但模拟器设置为困难气道。对所有插管尝试测量声门开口百分比（POGO）评分、插管时间和插管成功率。
发现头部抬高是正常气道中最有效的辅助操作，使平均POGO评分比对照提高27%（P = 0.002），而外部喉部操作在困难气道中最有效，使平均POGO评分提高21%（P = 0.009），成功插管比例提高41%（P < 0.001）。所有操作均缩短了正常气道和困难气道中的插管时间，并且与困难气道中与对照相比插管成功率的显著差异相关。
本研究确定在一组新手插管者中，头部抬高是改善正常气道喉镜视野最有效的操作，而外部喉部操作是困难气道中最有效的操作。斯坦因C、格伯L、柯廷D、奥伯雷姆N、韦尔斯M。三种操作及其对新手插管者在模拟气道中喉镜视野、插管时间和插管结果的影响比较。《院前急救与灾难医学》。2017年；32(4):419 - 423。
