Jaga Rudhir, Behari Dinell, Doubell Anton P, Bergh Kobus, Candy Sally, Hofmeyr Ross
Department of Anaesthesia & Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
Department of Radiology, University of Cape Town, Cape Town, South Africa.
Afr J Emerg Med. 2022 Dec;12(4):373-377. doi: 10.1016/j.afjem.2022.07.008. Epub 2022 Aug 17.
Intended for use by prehospital first responders, the Lubo cervical collar is an adjustable, radiolucent, single-use device that incorporates a mechanical jaw thrust mechanism. The combination enables non-invasive airway management in cases of trauma where cervical motion restriction is necessary. The potential benefits include use as an airway adjuvant maintaining upper airway patency, reducing provider task loading. The limited research on the device efficacy and safety requires further investigation.
A randomized, crossover, interventional study was performed to compare mean differences in airway patency at the level of the uvula, epiglottis, tongue and soft palate with and without the Lubo collar in awake volunteers using magnetic resonance imaging (MRI). Fourteen participants each underwent two MRI scans of the upper airway: A control scan with no Lubo collar, and an intervention scan with the Lubo collar applied and jaw thrust mechanism activated. Two independent radiologists measured anterior-posterior diameter of the airway at four anatomical levels on the resulting MRI images.
There was no significant difference in mean airway diameter between the control and intervention measurements at any level. Mean (SD; 95% CI: p-value) differences were 0.9 mm (-2.38; 2.3 to 0.5; p=0.17) at the epiglottis, 0.5 mm (1.6; -0.5 to 1.4; p=0.29) at the soft palate, 0.2 mm (2.86; -1.4 to 1.9; p = 0.78) at the tongue, 0.4 mm (4.04; -1.9 to 2.7; p = 0.72) at the uvula.
The Lubo airway collar did not show a significant change in upper airway patency at four anatomical levels measured in awake adult participants. Further research is required to investigate its clinical use in patients that are unable to maintain upper airway tone. Groups of interest would include trauma, obstructive sleep apnoea, obesity and patients under general anaesthesia.
Lubo 颈托专为院前急救人员设计，是一种可调节的、射线可透过的一次性装置，内置机械下颌前推机制。这种组合能够在需要限制颈椎活动的创伤病例中进行无创气道管理。潜在益处包括用作气道辅助装置，维持上呼吸道通畅，减轻施救人员的工作负担。关于该装置有效性和安全性的研究有限，需要进一步调查。
进行了一项随机、交叉、干预性研究，以使用磁共振成像（MRI）比较清醒志愿者在佩戴和不佩戴 Lubo 颈托情况下，悬雍垂、会厌、舌头和软腭水平气道通畅度的平均差异。14 名参与者每人都接受了两次上呼吸道 MRI 扫描：一次是不佩戴 Lubo 颈托的对照扫描，另一次是佩戴 Lubo 颈托并启动下颌前推机制的干预扫描。两名独立的放射科医生在所得的 MRI 图像上的四个解剖水平测量气道的前后径。
在任何水平上，对照测量和干预测量之间的平均气道直径均无显著差异。会厌处的平均（标准差；95%置信区间：p 值）差异为 0.9 毫米（-2.38；2.3 至 0.5；p = 0.17），软腭处为 0.5 毫米（1.6；-0.5 至 1.4；p = 0.29），舌头处为 0.2 毫米（2.86；-1.4 至 1.9；p = 0.78），悬雍垂处为 0.4 毫米（4.04；-1.9 至 2.7；p = 0.72）。
在清醒的成年参与者测量的四个解剖水平上，Lubo 气道颈托并未显示出上呼吸道通畅度有显著变化。需要进一步研究以调查其在无法维持上呼吸道张力的患者中的临床应用。感兴趣的群体将包括创伤、阻塞性睡眠呼吸暂停、肥胖患者以及全身麻醉下的患者。
