From the Departments of Emergency Medicine and Pediatrics, University of Arizona College of Medicine, Banner University Medical Center Tucson, Tucson, AZ.
The University of Sydney School of Pharmacy|Royal Prince Alfred Hospital, 1Faculty of Medicine and Health|The University of Sydney|NSW, Sydney, Australia.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1098-e1103. doi: 10.1097/PEC.0000000000001911.
There is little literature describing the performance of video laryngoscopes for the intubation of pediatric patients in the emergency department (ED). The purpose of this study is to report our experience with direct laryngoscopy (DL), the C-MAC (CMAC), and the GlideScope (GVL) over a 10-year period in an urban academic pediatric ED.
This was an analysis of pediatric intubations prospectively recorded into a Continuous Quality Improvement database in an academic pediatric ED over a 10-year period. Between July 1, 2007, and June 30, 2017, emergency physicians recorded all consecutive intubations performed in the pediatric ED. The database included patient demographics and detailed information on each intubation such as age of the patient, reason for intubation, device(s) used, method of intubation, difficult airway characteristics, adverse events, number of intubation attempts, and outcome of each attempt. All patients younger than 18 years who underwent intubation by an emergency medicine resident using a DL or videolaryngoscope (CMAC or GVL) were included in the study. The primary outcome measure was first-pass success without adverse events (FPS-AE), which was defined as successful tracheal intubation on a single laryngoscope insertion without the occurrence of any adverse events during the peri-intubation period. A multivariate regression analysis was performed to control for potential confounders and included difficult airway characteristic, operator level of training, method of intubation, and patient age.
During the study period, 530 intubations were performed in pediatric patients. Of these, 493 intubations met the inclusion criteria and were analyzed (218 DL, 187 CMAC, 88 GVL). The FPS-AE with each device is as follows: DL, 54.1% (n = 118/218); CMAC, 64.0% (n = 119/187); and GVL, 52.3% (n = 46/88). In the logistic regression analysis, compared with DL, the CMAC was associated with a higher FPS-AE (odds ratio, 1.6 [95% confidence interval, 1.03-2.45]), whereas the GVL was not associated with an increased FPS-AE (odds ratio, 0.62 [95% confidence interval, 0.35-1.10]).
In this study of pediatric patients intubated in the ED, compared with DL, the CMAC was associated with an increased FPS-AE, but the GVL was not.
描述我们在城市学术儿科急诊部（ED）使用视频喉镜进行小儿患者插管的经验，这方面的文献很少。本研究的目的是报告我们在过去 10 年中使用直接喉镜（DL）、C-MAC（CMAC）和 GlideScope（GVL）的经验。
这是一项对小儿插管的分析，这些插管是在过去 10 年中通过学术儿科 ED 的持续质量改进数据库前瞻性记录的。2007 年 7 月 1 日至 2017 年 6 月 30 日期间，急诊医师记录了在儿科 ED 进行的所有连续插管。该数据库包括患者人口统计学资料和每次插管的详细信息，如患者年龄、插管原因、使用的设备、插管方法、困难气道特征、不良事件、插管次数以及每次尝试的结果。所有接受急诊住院医师使用 DL 或视频喉镜（CMAC 或 GVL）进行插管的年龄小于 18 岁的患者均纳入研究。主要结局指标是无不良事件的首次通过成功率（FPS-AE），定义为在围插管期无任何不良事件的情况下，单次喉镜插入成功进行气管插管。进行了多变量回归分析，以控制潜在的混杂因素，包括困难气道特征、操作人员的培训水平、插管方法和患者年龄。
在研究期间，对 530 名儿科患者进行了插管。其中，493 例符合纳入标准并进行了分析（218 例 DL、187 例 CMAC、88 例 GVL）。每种设备的 FPS-AE 如下：DL，54.1%（n=118/218）；CMAC，64.0%（n=119/187）；GVL，52.3%（n=46/88）。在逻辑回归分析中，与 DL 相比，CMAC 与更高的 FPS-AE 相关（优势比，1.6[95%置信区间，1.03-2.45]），而 GVL 与增加的 FPS-AE 无关（优势比，0.62[95%置信区间，0.35-1.10]）。
在这项对 ED 中插管的儿科患者的研究中，与 DL 相比，CMAC 与增加的 FPS-AE 相关，但 GVL 则不然。
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