Kriege Marc, Rissel Rene, El Beyrouti Hazem, Hotz Eric
Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, 55131 Mainz, Germany.
Department of Cardiac and Vascular Surgery, University Medical Centre of the Johannes Gutenberg-University, 55131 Mainz, Germany.
J Clin Med. 2023 Sep 19;12(18):6060. doi: 10.3390/jcm12186060.
Tracheal intubation in critical care is a high-risk procedure requiring significant expertise and airway strategy modification. We hypothesise that awake tracheal intubation is associated with a lower incidence of severe adverse events compared to standard tracheal intubation in critical care patients.
Records were acquired for all tracheal intubations performed from 2020 to 2022 for critical care patients at a tertiary hospital. Each awake tracheal intubation case, using a videolaryngoscope with a hyperangulated blade (McGrath MAC X-Blade), was propensity matched with two controls (1:2 ratio; standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL) undergoing general anaesthesia). The primary endpoint was the incidence of adverse events, defined as a mean arterial pressure of <55 mmHg (hypotension), SpO < 80% (desaturation) after sufficient preoxygenation, or peri-interventional cardiac arrest.
Of the 135 tracheal intubations included for analysis, 45 involved the use of an awake tracheal intubation. At least one adverse event occurred after tracheal intubation in 36/135 (27%) of patients, including awake 1/45 (2.2%; 1/1 hypotension), VL 10/45 (22%; 6/10 hypotension and 4/10 desaturation), and DL 25/45 (47%; 10/25 hypotension, 12/25 desaturation, and 3/25 cardiac arrest; < 0.0001).
In this retrospective observational study of intubation practices in critical care patients, awake tracheal intubation was associated with a lower incidence of severe adverse events than anaesthetised tracheal intubation.
重症监护中的气管插管是一项高风险操作，需要专业技能和气道策略调整。我们假设，与重症监护患者的标准气管插管相比，清醒气管插管严重不良事件的发生率更低。
收集了一家三级医院2020年至2022年对重症监护患者进行的所有气管插管记录。每例使用带超角度镜片（麦格拉思MAC X镜片）的视频喉镜进行的清醒气管插管病例，按倾向得分与两个对照组（1:2比例；接受全身麻醉的标准插管视频喉镜检查（VL）和直接喉镜检查（DL））进行匹配。主要终点是不良事件的发生率，定义为平均动脉压<55 mmHg（低血压）、充分预充氧后SpO<80%（血氧饱和度降低）或介入期间心脏骤停。
纳入分析的135例气管插管中，45例采用清醒气管插管。36/135（27%）的患者在气管插管后至少发生了一次不良事件，包括清醒组1/45（2.2%；1例低血压）、VL组10/45（22%；6例低血压和4例血氧饱和度降低）和DL组25/45（47%；10例低血压、12例血氧饱和度降低和3例心脏骤停；P<0.0001）。
在这项对重症监护患者插管操作的回顾性观察研究中，清醒气管插管与麻醉气管插管相比，严重不良事件的发生率更低。
