Kingma Kirsten, Hofmeyr Ross, Zeng Irene Suilan, Coomarasamy Christin, Brainard Andrew
Department of Medicine, Stellenbosch University, Stellenbosch, South Africa.
Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Emerg Med Australas. 2017 Dec;29(6):650-657. doi: 10.1111/1742-6723.12874. Epub 2017 Nov 7.
Endotracheal intubation requires laryngoscopy followed by passage of the endotracheal tube (ETT). Tube passage can be difficult, but there is little evidence to support which adjunct for tube passage is most effective.
The four tube passage adjuncts tested were the naked ETT, stylet ETT, railroaded bougie and preloaded bougie. Participants completed pre- and post-test surveys identifying demographics, experience and method preference. After instruction, participants completed eight intubations on manikins with 'easy' and 'difficult' airways.
One hundred and seventeen practitioners who were experienced emergency medicine physicians, anaesthesiologists and out-of-hospital providers completed 936 total ETT attempts. For the 'difficult' airway, the percentage first pass success (95% confidence interval [CI]) for the naked ETT was 30.8% (23.1-39.7%). This was significantly lower than the stylet ETT (95.7% [86.6-100%]), the railroaded bougie (75.2% [63.8-86.6%]), or the preloaded bougie (89.7% [79.7-99.7%]). On difficult airways, the median (interquartile range [IQR]) time-to-intubation was fastest in the stylet ETT (25.0 s [20.9-32.2 s]) with the railroaded bougie being the slowest (43.2 s [36.5-56.2 s]). Seventy-nine per cent of participants stated that they would change their practice based on participating in this study. Participants increased their preference for the preloaded bougie from 30.6% to 69.4%.
The data show that tube passage with a stylet ETT or a preloaded bougie is superior in terms of higher first pass success, faster time-to-intubation and higher post-test preference. The naked ETT is clearly inferior to other methods. This research supports the recommendation to use a stylet ETT or bougie for every predicted difficult intubation.
气管插管需要先进行喉镜检查，然后插入气管内导管（ETT）。导管插入可能会很困难，但几乎没有证据支持哪种辅助导管插入的方法最有效。
测试的四种导管插入辅助工具分别是裸ETT、带管芯ETT、引导探条引导插入和预装引导探条。参与者完成了测试前和测试后的调查问卷，内容包括人口统计学信息、经验和方法偏好。在接受指导后，参与者在模拟有“简单”和“困难”气道的人体模型上完成了8次插管操作。
117名有经验的急诊医学医生、麻醉医生和院外急救人员共进行了936次ETT插入尝试。对于“困难”气道，裸ETT的首次插入成功率（95%置信区间[CI]）为30.8%（23.1 - 39.7%）。这显著低于带管芯ETT（95.7%[86.6 - 100%]）、引导探条引导插入（75.2%[63.8 - 86.6%]）或预装引导探条（89.7%[79.7 - 99.7%]）。在困难气道上，带管芯ETT的插管中位时间（四分位间距[IQR]）最快（25.0秒[20.9 - 32.2秒]），引导探条引导插入最慢（43.2秒[36.5 - 56.2秒]）。79%的参与者表示他们会基于参与本研究而改变其操作方法。参与者对预装引导探条的偏好从30.6%增加到了69.4%。
数据表明，带管芯ETT或预装引导探条在首次插入成功率更高、插管时间更快以及测试后偏好更高方面更具优势。裸ETT明显不如其他方法。本研究支持对每例预计困难插管使用带管芯ETT或引导探条的建议。
