Epp Katharina, Zimmermann Sophie, Wittenmeier Eva, Kriege Marc, Dette Frank, Schmidtmann Irene, Pirlich Nina
Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany.
Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany.
J Clin Med. 2022 Sep 26;11(19):5676. doi: 10.3390/jcm11195676.
Background: Airway management in children is challenging due to anatomical and physiological differences. This randomized trial investigates whether anaesthesia residents can intubate the paediatric trachea more quickly and with a higher success rate using the King Vision™ Paediatric aBlade™ video laryngoscope (KVL) compared to conventional direct laryngoscopy (DL). Methods: Eleven anaesthesia residents (mean age: 31 years, mean training status 47 months) were each asked to perform intubations with the KVL and DL in paediatric patients. The primary outcome was the first-attempt success rate. Secondary outcomes were the time to best view (TTBV), time to placement of the tracheal tube (TTP), time to ventilation (TTV), and participant-reported ease of use on a Likert scale. Results: 105 intubations with the KVL and 106 DL were performed by the residents. The success rate on the first attempt with the KVL was 81%, and the success rate on the first attempt within a given time limit of 30 s was 45%, which was lower than with DL (93% and 77% with time limit, p < 0.01). The median TTBV [IQR] on the first attempt with KVL was 7 [5−10] s, the median TTP was 28 [19−44] s, and the median TTV was 51 [39−66] s. DL-mediated intubation was significantly faster (TTP: 17 [13−23] s; p < 0.0001 and TTV: 34 [28−44] s; p < 0.001). Application of the KVL was rated as difficult or very difficult by 60% of the residents (DL: 5%). Conclusion: In contrast to promising data on the paediatric training manikin, residents took longer to intubate the airway in children with the KVL and were less successful compared to the DL. Therefore, the KVL should not be recommended for learning paediatric intubation by residents.
由于解剖学和生理学差异，儿童气道管理具有挑战性。本随机试验调查了与传统直接喉镜检查（DL）相比，麻醉住院医师使用King Vision™儿科aBlade™视频喉镜（KVL）进行小儿气管插管是否能更快且成功率更高。方法：11名麻醉住院医师（平均年龄：31岁，平均培训状态47个月）分别被要求对儿科患者使用KVL和DL进行插管。主要结局是首次尝试成功率。次要结局是获得最佳视野的时间（TTBV）、气管导管置入时间（TTP）、通气时间（TTV），以及参与者根据李克特量表报告的易用性。结果：住院医师使用KVL进行了105次插管，使用DL进行了106次插管。KVL首次尝试成功率为81%，在30秒给定时间限制内首次尝试成功率为45%，低于DL（时间限制下分别为93%和77%，p<0.01）。KVL首次尝试时的中位TTBV[四分位间距]为7[5 - 10]秒，中位TTP为28[19 - 44]秒，中位TTV为51[39 - 66]秒。DL介导的插管明显更快（TTP：17[13 - 23]秒；p<0.0001，TTV：34[28 - 44]秒；p<0.001）。60%的住院医师将KVL的应用评为困难或非常困难（DL：5%）。结论：与儿科训练模型上令人鼓舞的数据相反，与DL相比，住院医师使用KVL为儿童气道插管的时间更长且成功率更低。因此，不建议住院医师使用KVL学习小儿插管。
