Okada Yohei, Nakayama Yujiro, Hashimoto Katsuhiko, Koike Kaoru, Watanabe Norio
Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Am J Emerg Med. 2021 Jun;44:250-256. doi: 10.1016/j.ajem.2020.03.058. Epub 2020 Apr 1.
Whether the ramped or sniffing laryngoscopy position is better for tracheal intubation is unclear. This study aimed to determine the efficacy and safety of tracheal intubation in the ramped versus sniffing position.
We conducted a systematic review and meta-analysis of randomized clinical trials to compare the ramped position with the sniffing position for tracheal intubation. We searched the databases of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Excerpta Medica Database (Embase), ClinicalTrials.gov, and World Health Organization Clinical Trials Registry Platform up to December 2018. We included randomized-controlled trials, trials of participants who required tracheal intubation in any setting, and that compared tracheal intubation in the ramped and the sniffing positions. Two authors independently screened the trials, extracted the data, and assessed the risk of bias. We conducted the meta-analysis using the random-effects model to calculate the pooled risk ratio with 95% confidence interval.
Of the 2631 titles/abstracts screened, three studies (representing 513 patients) were included in the meta-analysis. The pooled risk ratio with 95% confidence interval (CI) of the sniffing versus the ramped position was as follows: a first successful attempt, 0.97 (95% CI, 0.86-1.09; I = 55%); laryngoscopy attempts ≤2, 1.08 (95% CI, 0.88-1.31; I = 93%); and good glottic view with Cormack-Lehane grade ≤ 2, 0.86 (95% CI, 0.69-1.07; I = 86%).
This systematic review and meta-analysis indicated no favorable aspects of the ramped position as compared to the sniffing position. Thus, further research is warranted to identify which is better in tracheal intubation.
PROSPERO identifier, CRD42019116819.
对于气管插管而言，斜坡位喉镜检查还是嗅物位喉镜检查更好尚不清楚。本研究旨在确定斜坡位与嗅物位气管插管的有效性和安全性。
我们对随机临床试验进行了系统评价和荟萃分析，以比较气管插管时斜坡位与嗅物位的效果。我们检索了截至2018年12月的Cochrane对照试验中央注册库（CENTRAL）、医学期刊数据库（MEDLINE）、医学文摘数据库（Embase）、临床试验.gov以及世界卫生组织临床试验注册平台等数据库。我们纳入了随机对照试验、在任何情况下需要气管插管的参与者试验，以及比较斜坡位和嗅物位气管插管的试验。两位作者独立筛选试验、提取数据并评估偏倚风险。我们使用随机效应模型进行荟萃分析，以计算合并风险比及95%置信区间。
在筛选的2631篇标题/摘要中，三项研究（代表513例患者）纳入了荟萃分析。嗅物位与斜坡位相比，95%置信区间（CI）的合并风险比结果如下：首次成功尝试，0.97（95%CI，0.86 - 1.09；I² = 55%）；喉镜检查尝试次数≤2次，1.08（95%CI，0.88 - 1.31；I² = 93%）；声门暴露良好（Cormack - Lehane分级≤2级），0.86（95%CI，0.69 - 1.07；I² = 86%）。
本系统评价和荟萃分析表明，与嗅物位相比，斜坡位并无优势。因此，有必要进一步研究以确定哪种体位在气管插管中更佳。
PROSPERO标识符，CRD42019116819。
Zotero 插件