Shaylor Ruth, Weiniger Carolyn F, Rachman Evgeny, Sela Yarden, Kohn Aryeh, Lahat Sharon, Rimon Ayelet, Capua Tali
From the Department of Anesthesia, Tel Aviv Sourasky Medical Center.
Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, Affiliated to Ministry of Health.
Pediatr Emerg Care. 2023 Mar 1;39(3):159-161. doi: 10.1097/PEC.0000000000002923. Epub 2023 Feb 16.
Video laryngoscopy (VL) has been proposed to increase the likelihood of successful intubation in patients with predicted difficult airways such as those with Pierre Robin sequence (PRS). Prior studies have focused on the performance of anesthesiologists, who are generally considered airway experts. Our primary aim was to investigate the success rate of intubation using VL compared with direct laryngoscopy (DL) when attempted by pediatric residents on a PRS model.
Participants were administered a 5-minute refresher video on 2 VL techniques (CMAC, conventional geometry VL, and McGrath, unconventional geometry VL) and DL. The participants were asked to intubate the AirSim PRS infant manikin. The order of VL and DL use was randomly selected. All intubations were video recorded, and the recordings were analyzed by 3 anesthesiologists blinded to the participant's identity and previous experience.
Seventeen of 23 residents succeeded in intubating the PRS model using DL. Only 9 residents succeeded in intubating the PRS model using VL (conventional or unconventional geometry). Intubation success rate was higher when comparing DL with VL ( P = 0.04) and similar when comparing VL devices ( P = 0.69).
Contrary to expectation, the intubation success rate was lower using VL than with DL among pediatric residents. This should be considered when designing residency training and in real-life resuscitation.
视频喉镜检查（VL）已被提议用于提高预计气道困难患者（如患有皮埃尔·罗宾序列征（PRS）的患者）成功插管的可能性。先前的研究主要关注麻醉医生的操作表现，他们通常被认为是气道专家。我们的主要目的是调查儿科住院医师在PRS模型上使用VL与直接喉镜检查（DL）进行插管的成功率。
让参与者观看一段5分钟的关于两种VL技术（CMAC，传统几何形状的VL，以及麦格拉斯，非传统几何形状的VL）和DL的复习视频。要求参与者对AirSim PRS婴儿人体模型进行插管。VL和DL的使用顺序是随机选择的。所有插管过程均进行视频记录，由3名对参与者身份和既往经验不知情的麻醉医生对记录进行分析。
23名住院医师中有17名使用DL成功为PRS模型插管。只有9名住院医师使用VL（传统或非传统几何形状）成功为PRS模型插管。将DL与VL进行比较时，插管成功率更高（P = 0.04），而比较VL设备时成功率相似（P = 0.69）。
与预期相反，儿科住院医师使用VL的插管成功率低于DL。在设计住院医师培训和实际复苏时应考虑这一点。
