Booth Anton W G, Pungsornruk Karla, Llewellyn Stacey, Sturgess David, Vidhani Kim
Department of Anaesthesia, Princess Alexandra Hospital - Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia.
BJA Open. 2024 Jan 5;9:100250. doi: 10.1016/j.bjao.2023.100250. eCollection 2024 Mar.
Adult epiglottitis is a life-threatening airway emergency where airway protection is the immediate priority. Despite its importance, the optimal approach to airway management remains unclear. We performed a systematic review of the airway management for adult epiglottitis, including meta-analysis of trends over time.
We systematically searched PubMed, Ovid MEDLINE®, and Embase® for adult epiglottitis studies that described the airway management between 1980 and 2020. The primary outcome was the prevalence of airway intervention. Secondary outcomes were prevalence of tracheal intubation, tracheostomy, and failed intubation. A random-effects model meta-analysis was performed with subgroups defined by decade of study publication. Cases that described the specific method of airway intervention and severity of epiglottitis were included in a separate technique summary.
Fifty-six studies with 10 630 patients were included in the meta-analysis. The overall rate of airway intervention was 15.6% (95% confidence interval [CI] 12.9-18.8%) but the rate decreased from 20% to 10% between 1980 and 2020. The overall rate of tracheal intubation was 10.2% (95% CI 7.1-13.6%) and that of failed intubation was 4.2% (95% CI 1.4-8.0%). The airway technique summary included 128 cases, of which 75 (58.6%) were performed awake and 53 (41.4%) involved general anaesthesia. We identified 32 cases of primary technique failure.
The rate of airway intervention for adult epiglottitis has decreased over four decades to a current level of 10%. Tracheal intubation is a high-risk scenario with a 1 in 25 failure rate. Specific technique selection is most likely influenced by contextual factors including the severity of epiglottitis.
成人会厌炎是一种危及生命的气道急症，气道保护是首要任务。尽管其至关重要，但气道管理的最佳方法仍不明确。我们对成人会厌炎的气道管理进行了系统评价，包括对随时间变化趋势的荟萃分析。
我们系统检索了PubMed、Ovid MEDLINE®和Embase®，查找1980年至2020年间描述气道管理的成人会厌炎研究。主要结局是气道干预的发生率。次要结局是气管插管、气管切开术和插管失败的发生率。采用随机效应模型进行荟萃分析，根据研究发表的年代定义亚组。描述气道干预具体方法和会厌炎严重程度的病例纳入单独的技术总结。
荟萃分析纳入了56项研究，共10630例患者。气道干预的总体发生率为15.6%（95%置信区间[CI] 12.9 - 18.8%），但在1980年至2020年间从20%降至10%。气管插管的总体发生率为10.2%（95% CI 7.1 - 13.6%），插管失败率为4.2%（95% CI 1.4 - 8.0%）。气道技术总结纳入128例病例，其中75例（58.6%）在清醒状态下进行，53例（41.4%）涉及全身麻醉。我们确定了32例主要技术失败病例。
成人会厌炎的气道干预率在40年里有所下降，目前为10%。气管插管是一种高风险情况，失败率为二十五分之一。具体技术选择很可能受包括会厌炎严重程度在内的背景因素影响。
