视频喉镜使用 McGrath Mac 对全身麻醉期间需要助手进行插管的影响：一项多中心随机视频-无视频试验。

Influence of videolaryngoscopy using McGrath Mac on the need for a helper to perform intubation during general anaesthesia: a multicentre randomised video-no-video trial.

机构信息

Department of Anaesthesia, Hôpital Foch, Suresnes, France.

Department of Anaesthesia, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France.

出版信息

BMJ Open. 2022 Jan 3;12(1):e049275. doi: 10.1136/bmjopen-2021-049275.

DOI:10.1136/bmjopen-2021-049275

PMID:34980609

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8724720/

Abstract

OBJECTIVE

We hypothesised that videolaryngoscopy modifies practice of tracheal intubation.

DESIGN

Randomised single-blinded study (video and no-video groups).

SETTING

Three institutions: one academic, one non-profit and one profit.

PARTICIPANTS

Patients >18 years, requiring orotracheal intubation, without predicted difficult intubation. Non-inclusion criterion was patients requiring a rapid-sequence intubation. 300 patients were included, 271 randomised, 256 analysed: 123 in the no-video and 133 in the video groups.

INTERVENTION

Tracheal intubation using a McGrath Mac videolaryngoscope, the sequence being video recorded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the proportion of intubations where assistance is necessary on request of the operator. Secondary outcomes included intraoperative variables (intubation difficulty scale and its components, percentage of glottic opening score, oesophageal Intubation, duration of intubation, removal of the screen cover in the no-video group, global evaluation of the ease of intubation, bispectral index, heart rate and blood pressure), intraoperative and postoperative complications (hoarseness or sore throat) and cooperation of the anaesthesiology team.

RESULTS

Requirement for assistance was not decreased in the Video group: 36.1% (95% CI 27.9 to 44.9) vs 45.5% (95% CI 36.5 to 54.7) in the no-video group, p=0.74; OR: 0.7 (95% CI 0.4 to 1.1) and absolute risk: 0.10 (95% CI -0.03 to 0.22). Intubation difficulty scale was similar in both groups (p=0.05). Percentage of glottic opening score was better in the Video group (median of 100 (95% CI (100 to 100) and 80 (95%CI (80 to 90) in the no-video group; p<0.001) as Cormack and Lehane grade (p=0001). Ease of intubation was considered better in the video group (p<0.001). Other secondary outcomes were similar between groups. Screen cover was removed in 7.3% (95% CI (2.7 to 11.9)) of the cases in the video group. No serious adverse event occurred. Communication and behaviour within the anaesthesia team were appropriate in all cases.

CONCLUSION

In patients without predicted difficult intubation, videolaryngoscopy did not decrease the requirement for assistance to perform intubation.

TRIAL REGISTRATION NUMBER

NCT02926144; Results.

摘要

目的

我们假设视频喉镜会改变气管插管的操作方式。

设计

随机单盲研究（视频组和非视频组）。

地点

三个机构：一个学术机构、一个非营利机构和一个盈利机构。

患者

18 岁，需要经口气管插管，无预测性插管困难。排除标准为需要快速序贯插管的患者。共纳入 300 例患者，271 例随机分组，256 例分析：视频组 123 例，非视频组 133 例。

干预措施

使用 McGrath Mac 视频喉镜进行气管插管，操作过程进行视频记录。

主要和次要结局指标

主要结局指标为操作者要求辅助插管的比例。次要结局指标包括术中变量（插管困难评分及其组成部分、声门显露评分百分比、食管插管、插管时间、非视频组中屏幕盖的移除、插管难易程度的总体评估、双频谱指数、心率和血压）、术中及术后并发症（声音嘶哑或咽痛）和麻醉团队的合作情况。

结果

视频组并未降低对辅助插管的需求：36.1%（95%CI 27.9 至 44.9）与非视频组的 45.5%（95%CI 36.5 至 54.7）相比，p=0.74；比值比：0.7（95%CI 0.4 至 1.1），绝对风险：0.10（95%CI -0.03 至 0.22）。两组插管困难评分相似（p=0.05）。视频组声门显露评分百分比更好（中位数 100（95%CI 100 至 100）与非视频组的 80（95%CI 80 至 90）；p<0.001）和 Cormack-Lehane 分级（p=0001）。视频组认为插管更容易（p<0.001）。其他次要结局在两组间相似。视频组有 7.3%（95%CI 2.7 至 11.9）的病例移除了屏幕盖。未发生严重不良事件。在所有病例中，麻醉团队的沟通和行为均恰当。