Kim Ji-Hoon, Kim Sung Wook, Kim Young-Min, Cho Youngsuk, Lee Seung Joon
Department of Emergency Medicine, Bucheon St. Mary's Hospital Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Department of Emergency Medicine, School of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul Department of Emergency Medicine, Myongji Hospital, Goyang, Korea.
Medicine (Baltimore). 2018 Aug;97(34):e11984. doi: 10.1097/MD.0000000000011984.
Novice clinicians who have little or no clinical experience in tracheal intubation occasionally need a long time to perform the procedure when using a large curved blade. They also have a lower tracheal intubation success rate, especially in emergency situations, such as cardiac arrest, than experienced practitioners. This study aimed to investigate whether the size of the curved laryngoscope blade affects the outcomes of tracheal intubation performed by incoming interns on a manikin model.
After completing a pre-study survey, the participants (n = 221) were randomly assigned into the following 2 groups based on the curved blade size: size 3 (n = 111) and size 4 (n = 110) curved blade groups. This study was conducted during a 1-day boot camp for incoming interns. The participants performed tracheal intubations using Macintosh laryngoscopes with size 3 or 4 blades on a Laerdal Airway Trainer (Laerdal, Stavanger, Norway). Subsequently, the participants were asked to complete a post-study survey. The primary outcome was the time to successful intubation (TSI). Meanwhile, the secondary outcomes were the first-pass and overall success rates, self-reported proximal esophagus visualization, and esophageal intubation. All intubation attempts were recorded and assessed by a trained assistant. The data were analyzed using the Mann-Whitney U or Chi-square test.
No significant differences in the baseline characteristics were observed between the 2 groups. The size 3 curved blade group had significantly shorter TSI than the size 4 curved blade group [25.0 (21.0-35.0) vs 36.5 (24.0-80.5) seconds, P < .001]. In addition, the size 3 curved blade group had significantly higher first-pass and overall success rates than the size 4 group (P = .001 and P = .005, respectively). Meanwhile, the size 4 curved blade group showed higher proximal esophagus visualization and esophageal intubation incidence rates than the size 3 curved blade group.
The outcomes of direct orotracheal intubation performed by novice practitioners may be influenced by the blade's size. Significant emphasis should be given on key anatomical landmarks and progressive visualization for tracheal intubation during airway management training for novice clinicians.
在气管插管方面几乎没有或完全没有临床经验的新手临床医生在使用大弯叶片时，有时需要很长时间来完成该操作。与经验丰富的从业者相比，他们的气管插管成功率也较低，尤其是在心脏骤停等紧急情况下。本研究旨在调查弯喉镜叶片的尺寸是否会影响实习医生在人体模型上进行气管插管的结果。
在完成一项预研究调查后，参与者（n = 221）根据弯叶片尺寸被随机分为以下两组：3号尺寸组（n = 111）和4号尺寸组（n = 110）。本研究在为实习医生举办的为期一天的集训期间进行。参与者使用带有3号或4号叶片的Macintosh喉镜在Laerdal气道训练器（挪威斯塔万格的Laerdal公司）上进行气管插管。随后，要求参与者完成一项研究后调查。主要结果是成功插管时间（TSI）。同时，次要结果是首次通过成功率和总体成功率、自我报告的近端食管可视化情况以及食管插管情况。所有插管尝试均由一名经过培训的助手进行记录和评估。使用Mann-Whitney U检验或卡方检验对数据进行分析。
两组之间在基线特征方面未观察到显著差异。3号弯叶片组的TSI明显短于4号弯叶片组[25.0（21.0 - 35.0）秒对36.5（24.0 - 80.5）秒，P <.001]。此外，3号弯叶片组的首次通过成功率和总体成功率明显高于4号组（分别为P =.001和P =.005）。同时，4号弯叶片组的近端食管可视化率和食管插管发生率高于3号弯叶片组。
新手从业者进行直接经口气管插管的结果可能会受到叶片尺寸的影响。在新手临床医生的气道管理培训中，气管插管时应高度重视关键解剖标志和逐步可视化。
