比较视频喉镜和直接喉镜用于急诊科和 ICU 患者气管插管的不良事件：系统评价和荟萃分析。
Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients-a systematic review and meta-analysis.
机构信息
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China.
出版信息
Scand J Trauma Resusc Emerg Med. 2020 Feb 7;28(1):10. doi: 10.1186/s13049-020-0702-7.
OBJECTIVE
This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients.
METHODS
The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study.
RESULTS
Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very low-quality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators' expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03).
CONCLUSIONS
Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.
目的
本系统评价和荟萃分析旨在确定视频喉镜（VL）与直接喉镜（DL）相比，是否能降低急诊和 ICU 患者气管插管相关不良事件的发生。
方法
检索了 Cochrane 中央对照试验注册库、PubMed、EMBASE 和 Web of Science（从数据库建立到 2018 年 10 月 30 日）的最新内容。纳入了比较 VL 和 DL 用于急诊或 ICU 患者气管插管并报告不良事件发生率的随机对照试验（RCT）、准 RCT 和观察性研究。主要结局是食管插管（EI）的发生率。采用 Review Manager 5.3 软件进行荟萃分析，并评估每项合格 RCT 的偏倚风险。应用 ACROBAT-NRSi Cochrane 偏倚风险工具评估每项合格观察性研究的偏倚风险。
结果
有 23 项研究（13117 例患者）纳入本综述进行数据提取。荟萃分析显示，使用 VL 时 EI 的发生率较低（相对风险 [RR]，0.24；P<0.01；RCT 为高质量证据，观察性研究为极低质量证据）。基于研究类型、是否为心肺复苏研究或操作者专业知识的亚组分析显示，在所有亚组中（除了有经验的操作者，RR，0.44；P=0.09），与 DL 相比，使用 VL 时 EI 的发生率较低（P<0.01）。除了经验不足的操作者使用 VL 时发生低氧血症的发生率较低（P=0.03）外，其他不良事件的设备之间无显著差异（P>0.05）。
结论
根据本分析结果，我们得出结论，与 DL 相比，VL 可降低急诊和 ICU 患者气管插管时 EI 的风险，但对气管插管相关其他不良事件没有显著益处。
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