硬式喉镜气管插管技术——一项比较 740 例插管学习曲线的随机对照试验。
The skill of tracheal intubation with rigid scopes - a randomised controlled trial comparing learning curves in 740 intubations.
机构信息
Department of Anaesthesia, Cantonal Hospital Aarau, Aarau, Switzerland.
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
出版信息
BMC Anesthesiol. 2020 Oct 16;20(1):263. doi: 10.1186/s12871-020-01181-w.
BACKGROUND
Rigid scopes are successfully used for management of difficult airways, but learning curves have not been established.
METHODS
This randomised controlled trial was performed at the University Hospital Bern in Switzerland to establish learning curves for the rigid scopes Bonfils and SensaScope and to assess their performance. Fifteen consultant anaesthetists and 15 anaesthesia registrars performed a total of 740 intubations (10 to 20 intubations with each device per physician) in adult patients without predictors of a difficult airway under general anaesthesia. According to randomisation, physicians intubated the patient's trachea with either the Bonfils or the SensaScope. A maximum of three intubation attempts was allowed. Primary outcome was overall time to successful intubation. Secondary outcome parameters included first attempt success, first attempt success within 60 s, failures and adverse events.
RESULTS
A clear learning effect was demonstrated: Over 20 trials, intubations became 2.5-times quicker and first attempt intubation success probability increased by 21-28 percentage points. Fourteen and 20 trials were needed with the Bonfils and the SensaScope, respectively, to reach a 90% first attempt success probability. Intubation times were 23% longer (geometric mean ratio 1.23, 95% confidence interval 1.12-1.36, p < 0.001) and first attempt success was less likely (odds ratio 0.64, 95% confidence interval 0.45-0.92, p = 0.016) with the SensaScope. Consultants showed a tendency for a better first attempt success compared to registrars. Overall, 23 intubations (10 Bonfils, 13 SensaScope) failed. Adverse events were rare and did not differ between devices.
CONCLUSIONS
A clear learning effect was demonstrated for both rigid scopes. Fourteen intubations with the Bonfils and 20 intubations with the SensaScope were required to reach a 90% first attempt success probability. Learning of the technique seemed more complex with the SensaScope compared to the Bonfils.
TRIAL REGISTRATION
Current Controlled Trials, ISRCTN14429285 . Registered 28 September 2011, retrospectively registered.
背景
刚性喉镜已成功用于处理困难气道，但尚未建立学习曲线。
方法
本研究为随机对照试验，在瑞士伯尔尼大学医院进行，旨在建立 Bonfils 和 SensaScope 刚性喉镜的学习曲线并评估其性能。15 名顾问麻醉师和 15 名麻醉住院医师在全身麻醉下对无困难气道预测因素的成年患者进行了总共 740 次插管（每位医师用每种设备进行 10-20 次插管）。根据随机分组，医生使用 Bonfils 或 SensaScope 对患者的气管进行插管。允许最多进行三次插管尝试。主要结局是成功插管的总时间。次要结局参数包括首次尝试成功率、60 秒内首次尝试成功率、失败和不良事件。
结果
显示出明显的学习效果：在 20 多次试验中，插管时间缩短了 2.5 倍，首次尝试插管成功率提高了 21-28 个百分点。使用 Bonfils 和 SensaScope 分别需要 14 次和 20 次试验才能达到 90%的首次尝试成功率。插管时间延长 23%（几何均数比 1.23，95%置信区间 1.12-1.36，p<0.001），首次尝试成功率降低（比值比 0.64，95%置信区间 0.45-0.92，p=0.016）SensaScope。顾问与住院医师相比，首次尝试成功率有更好的趋势。总体上，有 23 次插管（10 次 Bonfils，13 次 SensaScope）失败。不良事件很少，且两种设备之间无差异。
结论
两种刚性喉镜均显示出明显的学习效果。使用 Bonfils 进行 14 次插管和 SensaScope 进行 20 次插管后，首次尝试成功率达到 90%。与 Bonfils 相比，SensaScope 技术的学习似乎更为复杂。
试验注册
当前对照试验，ISRCTN814429285。于 2011 年 9 月 28 日注册，回溯性注册。
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