Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Emerg Med J. 2021 Feb;38(2):125-131. doi: 10.1136/emermed-2020-209700. Epub 2020 Nov 10.
First-pass success (FPS) during intubation is associated with lower morbidity for paediatric patients. Using videolaryngoscopy (VL) recordings, we reviewed technical aspects of intubation, including factors associated with FPS in children.
We performed a retrospective study of intubation attempts performed using video-assisted laryngoscopy in a paediatric ED between January 2014 and December 2018. Data were abstracted from a quality assurance database, the electronic medical record and VL recordings. Our primary outcome was FPS. Intubation practices were analysed using descriptive statistics. Patient and procedural characteristics associated with FPS in univariate testing and clinical factors identified from the literature were included as covariates in a multivariable logistic regression. An exploratory analysis examined the relationship between position of the glottic opening on the video screen and FPS.
Intubation was performed during 237 patient encounters, with 231 using video-assisted laryngoscopy. Data from complete video recordings were available for 129 attempts (59%); an additional 31 (13%) had partial recordings. Overall, 173 (73%) of first attempts were successful. Adjusting for patient age, placing the blade tip into the vallecula adjusted OR ((aOR) 7.2 (95% CI 1.7 to 30.1)) and obtaining a grade 1 or 2a-modified Cormack-Lehane glottic view on the videolaryngoscope screen (aOR 6.1 (95% CI 1.5 to 25.7) relative to grade 2b) were associated with increased FPS in the subset of patients with complete recordings. Exploratory analysis suggested that FPS is highest (81%) and duration is shortest when the glottic opening is located in the second quintile of the video screen.
Placement of the blade tip into the vallecula regardless of blade type, sufficient glottic visualisation and locating the glottic opening within the second quintile of the video screen were associated with FPS using video-assisted laryngoscopy in the paediatric ED.
在儿童中，插管时的首次通过成功率（FPS）与较低的发病率相关。使用视频喉镜（VL）记录，我们回顾了插管的技术方面，包括与 FPS 相关的儿童因素。
我们对 2014 年 1 月至 2018 年 12 月期间在儿科 ED 使用视频辅助喉镜进行的插管尝试进行了回顾性研究。数据从质量保证数据库、电子病历和 VL 记录中提取。我们的主要结果是 FPS。使用描述性统计方法分析插管操作。在单变量检验中，与 FPS 相关的患者和程序特征以及文献中确定的临床因素被纳入多变量逻辑回归的协变量。一项探索性分析检查了视频屏幕上声门开口位置与 FPS 之间的关系。
在 237 次患者就诊中进行了插管，其中 231 次使用了视频辅助喉镜。有 129 次尝试（59%）有完整的视频记录，另外 31 次（13%）有部分记录。总体而言，首次尝试的成功率为 173 次（73%）。调整患者年龄后，将刀片尖端放入 vallecula 中（调整后的优势比（aOR）7.2（95%置信区间 1.7 至 30.1））和在 VL 屏幕上获得 1 级或 2a 级改良 Cormack-Lehane 声门视图（aOR 6.1（95%置信区间 1.5 至 25.7）相对于 2b 级）与完整记录患者的 FPS 增加相关。探索性分析表明，当声门开口位于视频屏幕的第二个五分位数时，FPS 最高（81%），持续时间最短。
在儿科 ED 中，使用视频辅助喉镜时，将刀片尖端放入 vallecula 中（无论刀片类型如何）、充分的声门可视化以及将声门开口定位在视频屏幕的第二个五分位数内与 FPS 相关。
