Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Division of Pulmonary, Allergy, and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN.
Department of Emergency Medicine, Denver Health, Denver, CO.
Ann Emerg Med. 2023 Oct;82(4):425-431. doi: 10.1016/j.annemergmed.2023.02.016. Epub 2023 Apr 5.
To compare the effect of the use of a video laryngoscope versus a direct laryngoscope on each step of emergency intubation: laryngoscopy (step 1) and intubation of the trachea (step 2).
In a secondary observational analysis of data from 2 multicenter, randomized trials that enrolled critically ill adults undergoing tracheal intubation but did not control for laryngoscope type (video laryngoscope vs direct laryngoscope), we fit mixed-effects logistic regression models examining the 1) the association between laryngoscope type (video laryngoscope vs direct laryngoscope) and the Cormack-Lehane grade of view and 2) the interaction between grade of view, laryngoscope type (video laryngoscope vs direct laryngoscope), and the incidence of successful intubation on the first attempt.
We analyzed 1,786 patients: 467 (26.2%) in the direct laryngoscope group and 1,319 (73.9%) in the video laryngoscope group. The use of a video laryngoscope was associated with an improved grade of view as compared with a direct laryngoscope (adjusted odds ratio for increasingly favorable grade of view 3.14, 95% confidence interval [CI] 2.47 to 3.99). Successful intubation on the first attempt occurred in 83.2% of patients in the video laryngoscope group and 72.2% of patients in the direct laryngoscope group (absolute difference 11.1%, 95% CI 6.5% to 15.6%). Video laryngoscope use modified the association between grade of view and successful intubation on the first attempt such that intubation on the first attempt was similar between video laryngoscope and direct laryngoscope at a grade 1 view and higher for video laryngoscope than direct laryngoscope at grade 2 to 4 views (P<.001 for interaction term).
Among critically ill adults undergoing tracheal intubation, the use of a video laryngoscope was associated both with a better view of the vocal cords and with a higher probability of successfully intubating the trachea when the view of the vocal cords was incomplete in this observational analysis. However, a multicenter, randomized trial directly comparing the effect of a video laryngoscope with a direct laryngoscope on the grade of view, success, and complications is needed.
比较使用视频喉镜和直接喉镜对急诊插管的每个步骤的影响：喉镜检查（步骤 1）和气管插管（步骤 2）。
在对 2 项多中心、随机试验的二次观察性数据分析中，纳入了接受气管插管的危重症成年人，但未对喉镜类型（视频喉镜与直接喉镜）进行控制，我们拟合了混合效应逻辑回归模型，检查 1）喉镜类型（视频喉镜与直接喉镜）与 Cormack-Lehane 喉镜可见度分级之间的关联，2）可见度分级、喉镜类型（视频喉镜与直接喉镜）和首次尝试气管插管成功率之间的相互作用。
我们分析了 1786 例患者：直接喉镜组 467 例（26.2%），视频喉镜组 1319 例（73.9%）。与直接喉镜相比，使用视频喉镜与改善的喉镜可见度分级相关（优势比 3.14，95%置信区间[CI] 2.47 至 3.99）。视频喉镜组 83.2%的患者首次尝试插管成功，直接喉镜组 72.2%的患者首次尝试插管成功（绝对差异 11.1%，95%CI 6.5%至 15.6%）。视频喉镜的使用改变了可见度分级与首次尝试插管成功之间的关联，使得在可见度分级为 1 级及以上时，视频喉镜与直接喉镜的首次尝试插管成功率相似，而在可见度分级为 2 级至 4 级时，视频喉镜优于直接喉镜（交互项 P<.001）。
在接受气管插管的危重症成年人中，在这项观察性分析中，视频喉镜的使用与声带的更好视野以及在声带视野不完整时更有可能成功插管相关。然而，需要一项多中心、随机试验直接比较视频喉镜与直接喉镜对视野分级、成功率和并发症的影响。
