视频喉镜引导下在儿科重症监护病房进行的前瞻性观察性研究。
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
机构信息
Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine|, Philadelphia, Pennsylvania, USA.
Division of General Anesthesiology, Department of Anesthesiology and Critical Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
出版信息
Paediatr Anaesth. 2022 Sep;32(9):1015-1023. doi: 10.1111/pan.14505. Epub 2022 Jun 24.
BACKGROUND
There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room.
AIM
Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events.
METHODS
This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured.
RESULTS
Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI : -8% to 1%, p = .11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI : -6% to 5%, p = .75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI : -3% to 11%, p = .29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI : 23% to 51%, p < .001).
CONCLUSIONS
Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
背景
在手术室之外，有关视频喉镜在儿科患者中的使用数据有限。
目的
我们的主要目的是评估气管插管时使用视频喉镜引导的指导是否可行，其依从性是否高，以及是否与减少不良气管插管相关事件有关。
方法
这是一项在单中心儿科重症监护病房进行的视频喉镜实施的前后观察性研究，对气管插管使用视频喉镜和标准化指导语言进行标准化指导。视频喉镜作为一种带标准化指导语言的指导设备，作为实践改进的一部分被引入。2016 年 1 月至 2017 年 12 月期间，所有在儿科重症监护病房接受初次气管插管的患者，无论使用视频喉镜还是直接喉镜，均纳入本研究。采用实施率、持续依从性、气管插管结果（包括所有不良气管插管相关事件、氧饱和度下降（<80%SpO2）和首次尝试成功率）来评估该方案的实施情况。
结果
在 580 次气管插管中，284 次（49%）在实施前进行，296 次（51%）在实施后进行。使用标准化指导语言的视频喉镜的依从率很高（实施后 74%）且持续。两个阶段之间不良气管插管相关事件无统计学差异（前 9%比后 5%，绝对差异 3%，CI：-8%至 1%，p=0.11），氧饱和度下降<80%（前 13%比后 13%，绝对差异 1%，CI：-6%至 5%，p=0.75），或首次尝试成功率（前 73%比后 76%，绝对差异 4%，CI：-3%至 11%，p=0.29）。与标准直接喉镜相比，当使用视频喉镜进行气管插管时，主管更有可能使用标准化指导语言（80%比 43%，绝对差异 37%，CI：23%至 51%，p<0.001）。
结论
使用视频喉镜作为具有标准化指导语言的监督设备是可行的，且具有很高的依从性，但与不良气管插管相关事件和氧饱和度下降的发生率增加无关。
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