Emergency Department, Royal North Shore Hospital, Sydney, Australia.
Emergency Department, Royal North Shore Hospital, Sydney, Australia; Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, Australia; Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital, Sydney, Australia.
Am J Emerg Med. 2022 Jun;56:87-91. doi: 10.1016/j.ajem.2022.03.029. Epub 2022 Mar 18.
Optimal patient positioning during intubation improves laryngeal view and first pass success, as well as reducing incidence of hypoxia. In certain pre-hospital situations, it may be impractical or impossible for the operator to stand behind the patient.
We compared intubation in the supine and upright face-to-face positions, with regards to time to intubate and the view of the vocal cords obtained.
This was a pilot comparison study. One investigator intubated 25 cadavers with the use of a bougie in the supine and upright face-to-face positions. Each attempt was recorded on a video laryngoscope. Recordings of each attempt were reviewed by five blinded emergency physicians, who allocated both a percentage of glottic opening (POGO) score and Cormack-Lehane (CL) grade. Time to insertion of the endotracheal tube (ETT) through the vocal cords was measured from the video.
The median intubation time was 1 s longer for upright cadavers than for supine cadavers, with greater variation in intubation times for upright cadavers compared with supine cadavers (IQR 9.0 vs 3.5 excluding the outlier case). The mean POGO score (averaged across raters) was 4.7% lower for upright intubation attempts (excluding the outlier case) with a moderate-to-good degree of inter-rater reliability, however this difference was not statistically significant. The median CL grade (averaged across raters) was 0.2 higher for upright intubation attempts (excluding the outlier case) with a poor-to-moderate degree of inter-rater reliability, and this difference was also not statistically significant.
This pilot study suggests that upright, face-to-face intubation may be clinically similar to supine intubation in terms of time to intubation and difficulty. Further studies utilising a larger number of operators and cadaver types are indicated.
插管时患者的最佳体位可改善声门显露和首次插管成功率，并降低低氧血症的发生率。在某些院前情况下，术者可能无法或难以站在患者身后。
我们比较了仰卧位和仰卧位面对面体位下的插管情况，比较了插管时间和获得的声带显露情况。
这是一项初步比较研究。一名研究人员使用探条在仰卧位和仰卧位面对面体位下对 25 具尸体进行插管。每次尝试均在视频喉镜下进行记录。由 5 名盲法急救医生对每次尝试的录像进行评估，分别分配了声带显露百分比（POGO）评分和 Cormack-Lehane（CL）分级。通过视频测量声带内插入气管内导管（ETT）的时间。
与仰卧位尸体相比，直立尸体的插管时间中位数长 1 秒，且直立尸体的插管时间变化更大（排除离群值病例后 IQR 9.0 vs 3.5）。（排除离群值病例）直立插管尝试的平均 POGO 评分（平均评分）低 4.7%，评分者之间具有中度至高度可靠性，但差异无统计学意义。（排除离群值病例）直立插管尝试的平均 CL 分级（平均评分）高 0.2 级，评分者之间的可靠性差到中等，且差异无统计学意义。
这项初步研究表明，在插管时间和难度方面，直立面对面插管可能与仰卧位插管相似。需要进一步的研究，使用更多的操作者和更多类型的尸体。
