Ambrosio Art, Marvin Kastley, Perez Colleen, Byrnes Chelsie, Gaconnet Cory, Cornelissen Chris, Brigger Matthew
Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, Oceanside, California, USA.
OTO Open. 2017 May 8;1(2):2473974X17707916. doi: 10.1177/2473974X17707916. eCollection 2017 Apr-Jun.
Difficult airway management is a key skill required by all pediatric physicians, yet training on multiple modalities is lacking. The objective of this study was to compare the rate of, and time to, successful advanced infant airway placement with direct laryngoscopy, video-assisted laryngoscopy, and laryngeal mask airway (LMA) in a difficult airway simulator. This study is the first to compare the success with 3 methods for difficult airway management among pediatric trainees.
Randomized crossover pilot study.
Tertiary academic medical center.
Twenty-two pediatric residents, interns, and medical students were tested. Participants were provided 1 training session by faculty using a normal infant manikin. Subjects then performed all 3 of the aforementioned advanced airway modalities in a randomized order on a difficult airway model of a Robin sequence. Success was defined as confirmed endotracheal intubation or correct LMA placement by the testing instructor in ≤120 seconds.
Direct laryngoscopy demonstrated a significantly higher placement success rate (77.3%) than video-assisted laryngoscopy (36.4%, = .0117) and LMA (31.8%, = .0039). Video-assisted laryngoscopy required a significantly longer amount of time during successful intubations (84.8 seconds; 95% CI, 59.4-110.1) versus direct laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9) and LMA placement (36.6 seconds; 95% CI, 24.7-48.4).
Pediatric trainees demonstrated significantly higher success using direct laryngoscopy in a difficult airway simulator model. However, given the potential lifesaving implications of advanced airway adjuncts, including video-assisted laryngoscopy and LMA placement, more extensive training on adjunctive airway management techniques may be useful for trainees.
困难气道管理是所有儿科医生必备的一项关键技能，但针对多种方式的培训却很缺乏。本研究的目的是在困难气道模拟器中比较直接喉镜检查、视频辅助喉镜检查和喉罩气道（LMA）进行高级婴儿气道置入的成功率及所需时间。本研究是首次比较儿科受训人员使用三种方法进行困难气道管理的成功率。
随机交叉试点研究。
三级学术医疗中心。
对22名儿科住院医师、实习医生和医学生进行测试。教员使用正常婴儿人体模型为参与者提供1次培训课程。然后，受试者在罗宾序列的困难气道模型上以随机顺序进行上述所有三种高级气道置入方式的操作。成功定义为测试教员在≤120秒内确认气管插管成功或喉罩置入正确。
直接喉镜检查显示的置入成功率（77.3%）显著高于视频辅助喉镜检查（36.4%，P = 0.0117）和喉罩气道（31.8%，P = 0.0039）。成功插管期间，视频辅助喉镜检查所需时间（84.8秒；95%置信区间，59.4 - 110.1）显著长于直接喉镜检查（44.9秒；95%置信区间，33.8 - 55.9）和喉罩置入（36.6秒；95%置信区间，24.7 - 48.4）。
在困难气道模拟器模型中，儿科受训人员使用直接喉镜检查的成功率显著更高。然而，鉴于包括视频辅助喉镜检查和喉罩置入在内的高级气道辅助工具可能具有挽救生命的意义，对气道辅助管理技术进行更广泛的培训可能对受训人员有用。
