困难气道儿童经声门上气道行视频喉镜检查与纤维支气管镜插管的比较：多中心儿科困难插管登记研究分析
Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry.
作者信息
Burjek Nicholas E, Nishisaki Akira, Fiadjoe John E, Adams H Daniel, Peeples Kenneth N, Raman Vidya T, Olomu Patrick N, Kovatsis Pete G, Jagannathan Narasimhan, Hunyady Agnes, Bosenberg Adrian, Tham See, Low Daniel, Hopkins Paul, Glover Chris, Olutoye Olutoyin, Szmuk Peter, McCloskey John, Dalesio Nicholas, Koka Rahul, Greenberg Robert, Watkins Scott, Patel Vikram, Reynolds Paul, Matuszczak Maria, Jain Ranu, Khalil Samia, Polaner David, Zieg Jennifer, Szolnoki Judit, Sathyamoorthy Kumar, Taicher Brad, Riveros Perez N Ricardo, Bhattacharya Solmaletha, Bhalla Tarun, Stricker Paul, Lockman Justin, Galvez Jorge, Rehman Mohamed, Von Ungern-Sternberg Britta, Sommerfield David, Soneru Codruta, Chiao Franklin, Richtsfeld Martina, Belani Kumar, Sarmiento Lina, Mireles Sam, Bilen Rosas Guelay, Park Raymond, Peyton James
机构信息
From the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (N.E.B., N.J.); Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.N., J.E.F., K.N.P.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida (H.D.A.); Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio (V.T.R.); Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health System of Texas, Dallas, Texas (P.N.O.); and Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts (P.G.K.). Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health System of Texas, Dallas, Texas Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi Department of Anesthesiology, Duke University, Durham, North Carolina Department of Anesthesiology and Pain Management, Children's Hospital of Cleveland Clinic, Cleveland, Ohio Department of Anesthesia, Critical Care and Pain, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico Department of Anesthesiology, Weill Cornell Medical College, New York, New York Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Department of Anesthesiology, National Institute of Pediatrics, Mexico City, Mexico Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts.
出版信息
Anesthesiology. 2017 Sep;127(3):432-440. doi: 10.1097/ALN.0000000000001758.
BACKGROUND
The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques.
METHODS
Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy.
RESULTS
Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt.
CONCLUSIONS
In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.
背景
各种困难气道儿童插管技术的成功率及相关并发症仍不明确。本研究的主要目的是比较声门上气道光纤插管与视频喉镜在困难气道儿童中的成功率。次要目的是比较这些技术的并发症发生率。
方法
在处理困难儿童气道后，从14个地点收集观察数据。记录每个病例的患者年龄、插管技术、每次尝试的成功率、持续通气的使用情况及并发症。比较声门上气道光纤插管和视频喉镜处理患者的首次尝试成功率及并发症。
结果
声门上气道光纤插管和视频喉镜的首次尝试成功率相似（114例中的67例，59% 对比786例中的404例，51%；优势比1.35；95%可信区间，0.91至2.00；P = 0.16）。在1岁以下的患者中，声门上气道光纤插管的首次尝试成功率高于视频喉镜（35例中的19例，54% 对比220例中的79例，36%；优势比2.12；95%可信区间，1.04至4.31；P = 0.042）。两组的并发症发生率相似（20%对比13%；P = 0.096）。在光纤插管尝试过程中全程通过声门上气道进行持续通气时，低氧血症的发生率较低。
结论
在这项非随机研究中，声门上气道光纤插管和视频喉镜的首次尝试成功率相似。在困难气道婴儿中，声门上气道光纤插管的首次尝试成功率高于视频喉镜。光纤插管尝试过程中通过声门上气道进行持续通气可能会降低低氧血症的发生率。
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