Nikolla Dhimitri A, Beaumont Ryann R, Lerman Jessica L, Datsko Joseph S, Carlson Jestin N
Department of Emergency Medicine Allegheny Health Network-Saint Vincent Hospital, Erie Pennsylvania.
J Am Coll Emerg Physicians Open. 2020 Mar 13;1(3):257-262. doi: 10.1002/emp2.12035. eCollection 2020 Jun.
The ramped position is often used during endotracheal intubation to improve oxygenation, improve laryngeal views, and reduce airway complications. We sought to compare the impact of ramp angle and bed height on intubation outcomes during simulated endotracheal intubation.
We enrolled emergency medicine residents and fourth-year medical students to perform simulated direct laryngoscopy and endotracheal intubation in random order with the mannequin in the following combinations of ramp angles and bed heights; ramp angles of 25° and 45° at bed heights including knee, mid-thigh, umbilicus, xiphoid, and nipple/intermammary fold. Our primary outcome was the reported percentage of glottic opening (POGO) score. Secondary outcomes included number of laryngoscopy attempts and intubation time.
We enrolled 25 participants. There was no difference in reported POGO scores at 25° between bed heights, but at 45°, the umbilicus bed height had an improved reported POGO score (20; 95% confidence interval [CI] 7-33, < 0.01) relative to xyphoid. The nipple/inframammary fold height required longer intubation times in seconds (mean difference [MD] 95% CI) at 25°, (MD, 23.9 [4.6-37.6], < 0.01) and more laryngoscopy attempts at 45° (MD, 0.48 [0.16-0.79], < 0.01) relative to xyphoid. There was no difference in laryngoscopy attempts and video POGO between 25° and 45° at all bed heights, but reported POGO at the umbilicus position was better at 25° than 45° (12 [1-23], = 0.03).
The umbilicus bed height resulted in the highest reported POGO at 45°. Nipple/inframammary fold height resulted in worse intubating conditions.
在气管插管过程中，斜坡位常被用于改善氧合、改善喉镜视野并减少气道并发症。我们试图比较斜坡角度和床高对模拟气管插管过程中插管结果的影响。
我们招募了急诊医学住院医师和四年级医学生，让他们对人体模型按照以下斜坡角度和床高的组合以随机顺序进行模拟直接喉镜检查和气管插管；斜坡角度为25°和45°，床高包括膝盖、大腿中部、脐部、剑突和乳头/乳腺间皱襞。我们的主要结局是报告的声门开放百分比（POGO）评分。次要结局包括喉镜检查尝试次数和插管时间。
我们招募了25名参与者。在25°时，不同床高的报告POGO评分没有差异，但在45°时，相对于剑突水平，脐部床高的报告POGO评分有所改善（20；95%置信区间[CI] 7 - 33，<0.01）。相对于剑突水平，在25°时，乳头/乳腺下皱襞高度的插管时间更长（平均差[MD] 95% CI）（MD，23.9 [4.6 - 37.6]，<0.01），在45°时喉镜检查尝试次数更多（MD，0.48 [0.16 - 0.79]，<0.01）。在所有床高上，25°和45°之间的喉镜检查尝试次数和视频POGO没有差异，但脐部位置在25°时的报告POGO比45°时更好（12 [1 - 23]，=0.03）。
在45°时，脐部床高导致报告的POGO最高。乳头/乳腺下皱襞高度导致插管条件更差。
