视频喉镜辅助指导可减少儿科重症监护病房中与气管插管相关的不良事件。
Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU.
机构信息
Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale University School of Medicine, New Haven, CT.
Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Kentucky College of Medicine, Lexington, KY.
出版信息
Crit Care Med. 2023 Jul 1;51(7):936-947. doi: 10.1097/CCM.0000000000005847. Epub 2023 Mar 27.
OBJECTIVES
To evaluate implementation of a video laryngoscope (VL) as a coaching device to reduce adverse tracheal intubation associated events (TIAEs).
DESIGN
Prospective multicenter interventional quality improvement study.
SETTING
Ten PICUs in North America.
PATIENTS
Patients undergoing tracheal intubation in the PICU.
INTERVENTIONS
VLs were implemented as coaching devices with standardized coaching language between 2016 and 2020. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches.
MEASUREMENTS AND MAIN RESULTS
The primary outcome was TIAEs. Secondary outcomes included severe TIAEs, severe hypoxemia (oxygen saturation < 80%), and first attempt success. Of 5,060 tracheal intubations, a VL was used in 3,580 (71%). VL use increased from baseline (29.7%) to implementation phase (89.4%; p < 0.001). VL use was associated with lower TIAEs (VL 336/3,580 [9.4%] vs standard laryngoscope [SL] 215/1,480 [14.5%]; absolute difference, 5.1%; 95% CI, 3.1-7.2%; p < 0.001). VL use was associated with lower severe TIAE rate (VL 3.9% vs SL 5.3%; p = 0.024), but not associated with a reduction in severe hypoxemia (VL 15.7% vs SL 16.4%; p = 0.58). VL use was associated with higher first attempt success (VL 71.8% vs SL 66.6%; p < 0.001). In the primary analysis after adjusting for site clustering, VL use was associated with lower adverse TIAEs (odds ratio [OR], 0.61; 95% CI, 0.46-0.81; p = 0.001). In secondary analyses, VL use was not significantly associated with severe TIAEs (OR, 0.72; 95% CI, 0.44-1.19; p = 0.20), severe hypoxemia (OR, 0.95; 95% CI, 0.73-1.25; p = 0.734), or first attempt success (OR, 1.28; 95% CI, 0.98-1.67; p = 0.073). After further controlling for patient and provider characteristics, VL use was independently associated with a lower TIAE rate (adjusted OR, 0.65; 95% CI, 0.49-0.86; p = 0.003).
CONCLUSIONS
Implementation of VL-assisted coaching achieved a high level of adherence across the PICUs. VL use was associated with reduced adverse TIAEs.
目的
评估视频喉镜（VL）作为一种教练设备来减少不良气管插管相关事件（TIAE）的实施效果。
设计
前瞻性多中心干预质量改进研究。
地点
北美 10 个 PICUs。
患者
在 PICU 中接受气管插管的患者。
干预措施
2016 年至 2020 年期间，VL 被用作具有标准化教练语言的教练设备。鼓励喉镜医师仅使用实时视频图像进行直接喉镜检查，以供经验丰富的监督临床教练使用。
测量和主要结果
主要结果是 TIAE。次要结果包括严重 TIAE、严重低氧血症（氧饱和度<80%）和首次尝试成功。在 5060 次气管插管中，使用 VL 进行了 3580 次（71%）。VL 的使用从基线（29.7%）增加到实施阶段（89.4%；p<0.001）。VL 的使用与较低的 TIAE 相关（VL 336/3580 [9.4%] 与标准喉镜 [SL] 215/1480 [14.5%]；绝对差异，5.1%；95%CI，3.1-7.2%；p<0.001）。VL 的使用与较低的严重 TIAE 发生率相关（VL 3.9%与 SL 5.3%；p=0.024），但与严重低氧血症的减少无关（VL 15.7%与 SL 16.4%；p=0.58）。VL 的使用与更高的首次尝试成功率相关（VL 71.8%与 SL 66.6%；p<0.001）。在调整了站点聚类后进行的主要分析中，VL 的使用与较低的不良 TIAE 相关（比值比 [OR]，0.61；95%CI，0.46-0.81；p=0.001）。在二次分析中，VL 的使用与严重 TIAE（OR，0.72；95%CI，0.44-1.19；p=0.18）、严重低氧血症（OR，0.95；95%CI，0.73-1.25；p=0.734）或首次尝试成功率（OR，1.28；95%CI，0.98-1.67；p=0.073）无显著相关性。在进一步控制了患者和提供者特征后，VL 的使用与较低的 TIAE 发生率独立相关（调整后的 OR，0.65；95%CI，0.49-0.86；p=0.003）。
结论
VL 辅助教练在整个 PICUs 中实现了高水平的依从性。VL 的使用与减少不良 TIAE 相关。
Zotero 插件