Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France.
Département Anesthésie Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Centre Hospitalier Universitaire (CHU) Montpellier, 34295, Montpellier, France.
Intensive Care Med. 2022 Sep;48(9):1176-1184. doi: 10.1007/s00134-022-06832-9. Epub 2022 Aug 16.
To investigate the impact of Macintosh blade size used during direct laryngoscopy (DL) on first-attempt intubation success of orotracheal intubation in French intensive care units (ICUs). We hypothesized that success rate would be higher with Macintosh blade size No3 than with No4.
Multicenter retrospective observational study based on data from prospective trials conducted in 48 French ICUs of university, and general and private hospitals. After each intubation using Macintosh DL, patients' and operators' characteristics, Macintosh blade size, results of first DL and alternative techniques used, as well as the need of a second operator were collected. Complications rates associated with intubation were investigated. Primary outcome was success rate of first DL using Macintosh blade.
A total of 2139 intubations were collected, 629 with a Macintosh blade No3 and 1510 with a No4. Incidence of first-pass intubation after first DL was significantly higher with Macintosh blade No3 (79.5 vs 73.3%, p = 0.0025), despite equivalent Cormack-Lehane scores (p = 0.48). Complications rates were equivalent between groups. Multivariate analysis concluded to a significant impact of Macintosh blade size on first DL success in favor of blade No3 (OR 1.44 [95% CI 1.14-1.84]; p = 0.0025) without any significant center effect on the primary outcome (p = 0.18). Propensity scores and adjustment analyses concluded to equivalent results.
In the present study, Macintosh blade No3 was associated with improved first-passed DL in French ICUs. However, study design requires the conduct of a nationwide prospective multicenter randomized trial in different settings to confirm these results.
研究在法国重症监护病房（ICU）进行直接喉镜检查（DL）时使用的 Macintosh 叶片大小对经口气管插管首次尝试插管成功率的影响。我们假设 Macintosh 叶片尺寸 3 号的成功率会高于 4 号。
这是一项多中心回顾性观察性研究，基于在法国 48 家大学、综合和私立医院的 ICU 进行的前瞻性试验的数据。在每次使用 Macintosh DL 进行插管后，收集患者和操作者的特征、Macintosh 叶片尺寸、首次 DL 结果和替代技术的使用情况，以及是否需要第二名操作者。调查与插管相关的并发症发生率。主要结局是使用 Macintosh 叶片的首次 DL 成功率。
共收集了 2139 例插管，其中 Macintosh 叶片 3 号 629 例，4 号 1510 例。尽管 Cormack-Lehane 评分相当（p=0.48），但首次 DL 后首次插管成功率显著更高（79.5%比 73.3%，p=0.0025）。两组并发症发生率相当。多变量分析得出结论，Macintosh 叶片尺寸对首次 DL 成功率有显著影响，有利于叶片 3 号（OR 1.44[95%CI 1.14-1.84]；p=0.0025），而主要结局无显著中心效应（p=0.18）。倾向评分和调整分析得出了等效的结果。
在本研究中，Macintosh 叶片 3 号与法国 ICU 中首次通过 DL 成功率提高相关。然而，研究设计需要在不同环境下进行全国性的前瞻性多中心随机试验来确认这些结果。
