在重症监护病房进行气管插管期间，使用改良的Cormack-Lehane量表评估喉镜视野：一项前瞻性观察研究。

Evaluation of the laryngoscopy view using the modified Cormack-Lehane scale during tracheal intubation in an intensive care unit. A prospective observational study.

作者信息

Taboada M, Soto-Jove R, Mirón P, Martínez S, Rey R, Ferreiroa E, Almeida X, Álvarez J, Baluja A

机构信息

Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, España.

出版信息

Rev Esp Anestesiol Reanim (Engl Ed). 2019 May;66(5):250-258. doi: 10.1016/j.redar.2019.01.004. Epub 2019 Mar 9.

DOI:10.1016/j.redar.2019.01.004

PMID:30862397

Abstract

BACKGROUND AND OBJECTVIES

Tracheal intubation in the Intensive Care Unit is associated with a high incidence of difficult intubation and complications. This may be due to a poor view of the glottis during direct laryngoscopy. The aim of this study is to determine if there is a relationship between laryngoscopy view using the modified Cormack-Lehane scale with the incidence of difficult intubation and complications.

METHODS

All patients who were subjected to tracheal intubated with direct laryngoscopy in the Intensive Care Unit over a 45 month period were included in the study. In all patients, an evaluation was made of the laryngoscopy view using the modified Cormack-Lehane scale, as well as the technical difficulty (number of intubations at first attempt, operator-reported difficulty, need for a Frova introducer), and the incidence of complications (hypotension, hypoxia, oesophageal intubation).

RESULTS

A total of 360 patients were included. When the grade of the modified Cormack-Lehane scale was increased from 1 to 4, the incidence of first success rate intubation decreased (1: 97%, 2a: 94%, 2b: 80%, 3: 60%, 4: 0%, p<.001), the incidence of moderate and severe difficulty intubation increased (1: 2%, 2a: 4%, 2b: 36%, 3: 77%, 4: 100%, p<.001.), as well as the need for a Frova guide (1: 7%, 2a: 8%, 2b: 45%, 3: 60%, 4: 100%, p<.001). When the grade of the modified Cormack-Lehane scale increased from 1 to 4, the incidence of hypoxia<90% increased (1: 20%, 2a: 20%, 2b: 28%, 3: 47%, 4: 100%, p=.0073), as well as hypoxia<80% (1: 11%, 2a: 10%, 2b: 12%, 3: 27%, 4: 100%, p=.00398). No relationship was observed between the incidence of hypotension and the grade of the modified Cormack-Lehane scale (p=ns).

CONCLUSIONS

During tracheal intubation in the Intensive Care Unit a close relationship was found between a poor laryngoscopy view using the modified Cormack-Lehane scale and a higher difficulty technique of intubation. A relationship was found between the incidence of hypoxia with a higher grade in the modified Cormack-Lehane scale. No relationship was found between hypotension and the modified Cormack-Lehane scale.

摘要

背景与目的

重症监护病房中的气管插管与困难插管及并发症的高发生率相关。这可能是由于直接喉镜检查时声门视野不佳所致。本研究的目的是确定使用改良的Cormack-Lehane分级评估的喉镜视野与困难插管及并发症的发生率之间是否存在关联。

方法

纳入在45个月期间于重症监护病房接受直接喉镜下气管插管的所有患者。对所有患者使用改良的Cormack-Lehane分级评估喉镜视野，以及技术难度（首次尝试插管次数、操作者报告的难度、是否需要使用弗罗瓦导引器）和并发症发生率（低血压、低氧血症、食管插管）。

结果

共纳入360例患者。当改良的Cormack-Lehane分级从1级升至4级时，首次插管成功率下降（1级：97%，2a级：94%，2b级：80%，3级：60%，4级：0%，p<0.001），中度和重度困难插管的发生率增加（1级：2%，2a级：4%，2b级：36%，3级：77%，4级：100%，p<0.001），以及使用弗罗瓦导引器的需求增加（1级：7%，2a级：8%，2b级：45%，3级：60%，4级：100%，p<0.001）。当改良的Cormack-Lehane分级从1级升至4级时，血氧饱和度<90%的发生率增加（1级：20%，2a级：20%，2b级：28%，3级：47%，4级：100%，p=0.0073），血氧饱和度<80%的发生率也增加（1级：11%，2a级：10%，2b级：12%，3级：27%，4级：100%，p=0.00398）。未观察到低血压发生率与改良的Cormack-Lehane分级之间的关联（p=无显著差异）。