Louro Jack, Dudaryk Roman, Rodriguez Yvette, Dutton Richard P, Epstein Richard H
Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
Ryder Trauma Center, Jackson Health System, Miami, FL, USA.
Int J Crit Illn Inj Sci. 2020 Jan-Mar;10(1):20-24. doi: 10.4103/IJCIIS.IJCIIS_14_19. Epub 2020 Mar 6.
Rapid sequence induction and tracheal intubation through direct laryngoscopy (DL) has been the most common approach to secure the airway in trauma patients. The introduction of video laryngoscopy (VL) has changed airway management in many clinical settings. In this retrospective study, we assessed if immediate availability of VL in the trauma suite has changed the approach and outcomes of airway management during acute resuscitation at a dedicated trauma center.
We retrospectively collected data from emergency intubation in the 6 resuscitation bays at a high-volume, academic, Level 1 trauma center over a 42-month period following the introduction of immediately available VL in the resuscitation bay. We divided the data into 13-week bins to assess the trend in the use of VL over time. Our measured outcomes were the incidence of failed intubations requiring a surgical airway and the frequency of VL use for airway management.
Among 1328 airway management events in the resuscitation bays when intubation was attempted, the failure rate resulting in the placement of a surgical airway was 0.38% (95% confidence interval [CI], 0.12% -0.88%). This was consistent with the surgical airway rate before the introduction of VL into trauma practice (0.3%). VL use (primary or as a rescue technique) throughout the study period was 4.14% (95% CI, 2.76%-5.74%), with no temporal trend.
The immediate availability of VL in the resuscitation bay has not changed the prevalence of its use during emergency airway management at our trauma center. DL remains a preferred primary modality for airway management by the trauma anesthesiologists working at this facility, with an acceptably low incidence of both primary failure and the need to establish a surgical airway.
通过直接喉镜检查（DL）进行快速顺序诱导和气管插管一直是创伤患者气道管理的最常用方法。视频喉镜（VL）的引入改变了许多临床环境中的气道管理方式。在这项回顾性研究中，我们评估了创伤病房中VL的即时可用性是否改变了在专门创伤中心进行急性复苏期间气道管理的方法和结果。
在复苏病房引入即时可用的VL后的42个月期间，我们回顾性收集了一家大型学术一级创伤中心6个复苏区的急诊插管数据。我们将数据分为13周的时间段，以评估VL使用随时间的趋势。我们测量的结果是需要建立手术气道的插管失败发生率以及VL用于气道管理的频率。
在复苏区尝试插管的1328次气道管理事件中，导致建立手术气道的失败率为0.38%（95%置信区间[CI]，0.12%-0.88%）。这与VL引入创伤实践之前的手术气道率（0.3%）一致。在整个研究期间，VL的使用（作为主要或抢救技术）为4.14%（95%CI，2.76%-5.74%），且无时间趋势。
复苏病房中VL的即时可用性并未改变我们创伤中心在紧急气道管理期间其使用的普遍性。对于在该机构工作的创伤麻醉医生来说，DL仍然是气道管理的首选主要方式，初次失败率和建立手术气道的需求发生率都低至可接受。
