From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
Harborview Medical Center, Seattle, Washington.
Anesth Analg. 2018 Aug;127(2):450-454. doi: 10.1213/ANE.0000000000003374.
Airway management in the presence of acute cervical spine injury (CSI) is challenging. Because it limits cervical spine motion during tracheal intubation and allows for neurological examination after the procedure, awake fiberoptic bronchoscopy (FOB) has traditionally been recommended. However, with the widespread availability of video laryngoscopy (VL), its use has declined dramatically. Our aim was to describe the frequency of airway management techniques used in patients with CSI at our level I trauma center and report the incidence of neurological injury attributable to airway management.
Adults presenting to the operating room with CSI without a tracheal tube in situ between September 2010 and June 2017 were included. All patients were intubated in the presence of manual-in-line stabilization, a hard cervical collar, or surgical traction. Worsening neurological status was defined as new motor or sensory deficits on postoperative examination.
Two hundred fifty-two patients were included, of which 76 (30.2%) had preexisting neurological deficits. VL was the most frequent initial airway management technique used (49.6%). Asleep FOB was commonly performed alone (30.6%) or in conjunction with VL (13.5%). Awake FOB was rarely performed (2.3%), as was direct laryngoscopy (2.8%). All techniques were associated with high first-attempt success rates, and no cases of neurological injury attributable to airway management technique were identified.
Among patients with acute CSI at a high-volume academic trauma center, VL was the most commonly used initial intubation technique. Awake FOB and direct laryngoscopy were performed infrequently. No cases of neurological deterioration secondary to airway management occurred with any method. Assuming care is taken to limit neck movement, providers should use the intubation technique with which they have the most comfort and skill.
急性颈椎损伤（CSI）存在时的气道管理极具挑战性。由于其在气管插管过程中限制颈椎运动，并允许在操作后进行神经检查，因此传统上推荐使用清醒纤维支气管镜（FOB）。但是，随着视频喉镜（VL）的广泛应用，其使用量急剧下降。我们的目的是描述在我们的一级创伤中心，CSI 患者使用的气道管理技术的频率，并报告归因于气道管理的神经损伤发生率。
纳入 2010 年 9 月至 2017 年 6 月间在手术室中出现 CSI 且无气管内导管在位的成人患者。所有患者均在手动直线稳定、硬颈圈或手术牵引下插管。术后新出现的运动或感觉功能障碍定义为新的神经功能缺损。
共纳入 252 例患者，其中 76 例（30.2%）存在预先存在的神经功能缺损。VL 是最常使用的初始气道管理技术（49.6%）。睡眠 FOB 通常单独使用（30.6%）或与 VL 联合使用（13.5%）。清醒 FOB 很少使用（2.3%），直接喉镜也很少使用（2.8%）。所有技术的首次尝试成功率均很高，未发现因气道管理技术而导致的神经损伤病例。
在高容量学术创伤中心的急性 CSI 患者中，VL 是最常使用的初始插管技术。清醒 FOB 和直接喉镜的使用频率较低。任何方法都不会因气道管理而导致神经恶化。在限制颈部运动的前提下，应使用医护人员最熟悉和擅长的插管技术。
