Department of Anaesthesia, Northshore Hospital, Auckland, New Zealand.
Department of Anaesthesia, University Hospital Galway, Ireland.
Anaesthesia. 2018 Sep;73(9):1151-1161. doi: 10.1111/anae.14299. Epub 2018 Apr 17.
Awake fibreoptic intubation is often considered the technique of choice when a difficult airway is anticipated. However, videolaryngoscopes are being used more commonly. We searched the current literature and performed a meta-analysis to compare the use of videolaryngoscopy and fibreoptic bronchoscopy for awake tracheal intubation. Our primary outcome was the time needed to intubate the patient's trachea. Secondary outcomes included: failed intubation; the rate of successful intubation at the first attempt; patient-reported satisfaction with the technique; and any complications resulting from intubation. Eight studies examining 429 patients were included in this review. The intubation time was shorter when videolaryngoscopy was used instead of fibreoptic bronchoscopy (seven trials, 408 participants, mean difference (95%CI) -45.7 (-66.0 to -25.4) s, p < 0.0001, low-quality evidence). There was no significant difference between the two techniques in the failure rate (six studies, 355 participants, risk ratio (95%CI) 1.01 (0.24-4.35), p = 0.99, low-quality evidence) or the first-attempt success rate (six studies, 391 participants, risk ratio (95%CI) 1.01 (0.95-1.06), p = 0.8, moderate quality evidence). The level of patient satisfaction was similar between both groups. No difference was found in two reported adverse events: hoarseness/sore throat (three studies, 167 participants, risk ratio (95%CI) 1.07 (0.62-1.85), p = 0.81, low-quality evidence), and low oxygen saturation (five studies, 337 participants, risk ratio (95%CI) 0.49 (0.22-1.12), p = 0.09, low-quality evidence). In summary, videolaryngoscopy for awake tracheal intubation is associated with a shorter intubation time. It also seems to have a success rate and safety profile comparable to fibreoptic bronchoscopy.
当预计存在困难气道时，通常会选择清醒纤维光学插管作为首选技术。然而，视频喉镜的使用越来越普遍。我们检索了当前的文献，并进行了荟萃分析，以比较视频喉镜和纤维支气管镜用于清醒气管插管的效果。我们的主要结局是将患者气管插管所需的时间。次要结局包括：插管失败；首次尝试插管成功的比例；患者对技术的满意度；以及插管引起的任何并发症。本综述纳入了 8 项研究，共 429 名患者。与纤维支气管镜相比，使用视频喉镜进行插管的时间更短（7 项试验，408 名参与者，平均差值（95%CI）-45.7（-66.0 至-25.4）s，p<0.0001，低质量证据）。两种技术在插管失败率（6 项研究，355 名参与者，风险比（95%CI）1.01（0.24-4.35），p=0.99，低质量证据）或首次尝试成功率（6 项研究，391 名参与者，风险比（95%CI）1.01（0.95-1.06），p=0.8，中等质量证据）方面没有显著差异。两组患者的满意度水平相似。两种报道的不良事件之间没有差异：声音嘶哑/喉咙痛（3 项研究，167 名参与者，风险比（95%CI）1.07（0.62-1.85），p=0.81，低质量证据）和低氧饱和度（5 项研究，337 名参与者，风险比（95%CI）0.49（0.22-1.12），p=0.09，低质量证据）。总之，清醒气管插管时使用视频喉镜可缩短插管时间。它似乎也具有与纤维支气管镜相似的成功率和安全性。
