Ono Yuko, Shinohara Kazuaki, Shimada Jiro, Sugiyama Jun, Inoue Shigeaki, Kotani Joji
Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Emergency and Critical Care Medical Center, Fukushima Medical University, Fukushima, Japan.
Kobe J Med Sci. 2024 Feb 29;69(4):E151-E158. doi: 10.24546/0100486397.
Endotracheal intubation (ETI) is a common and crucial intervention. Whether the performance of ETI differs according to the sex of the laryngoscopist remains unclear. The aim of this study was to assess sex disparities in markers of ETI performance among novices using a high-fidelity simulator. This prospective observational study was conducted from April 2017 to March 2019 in a public medical university. In total, 209 medical students (4th and 5th grade) without clinical ETI experience were recruited. Of the 209 students, 64 (30.6%) were female. The participants used either a Macintosh direct laryngoscope or C-MAC video laryngoscope in combination with a stylet or gum-elastic bougie to perform ETI on a high-fidelity simulator. The primary endpoint was the maximum force applied on the maxillary incisors during laryngoscopy. The secondary endpoint was the time to ETI. The implanted sensors in the simulator automatically quantified the force and time to ETI. The maximum force applied on the maxillary incisors was approximately 30% lower in the male than female group for all laryngoscopes and intubation aids examined (all P < 0.001). Similarly, the time to ETI was approximately 10% faster in the male than female group regardless of the types of laryngoscopes and intubation aids used (all P < 0.05). In this study, male sex was associated with a lower maximum force applied on the maxillary incisors during both direct and indirect laryngoscopy performed by novices. A clinical study focusing on sex differences in ETI performance is needed to validate our findings.
气管插管（ETI）是一种常见且关键的干预措施。气管插管操作的表现是否因喉镜检查者的性别而异尚不清楚。本研究的目的是使用高保真模拟器评估新手在气管插管操作指标上的性别差异。这项前瞻性观察性研究于2017年4月至2019年3月在一所公立医科大学进行。总共招募了209名没有临床气管插管经验的医学生（四年级和五年级）。在这209名学生中，64名（30.6%）为女性。参与者使用麦金托什直接喉镜或C-MAC视频喉镜，并结合管芯或弹性树胶探条在高保真模拟器上进行气管插管操作。主要终点是喉镜检查期间对上颌切牙施加的最大力量。次要终点是气管插管的时间。模拟器中植入的传感器自动量化了气管插管的力量和时间。在所有检查的喉镜和插管辅助工具中，男性组对上颌切牙施加的最大力量比女性组低约30%（所有P<0.001）。同样，无论使用何种类型的喉镜和插管辅助工具，男性组的气管插管时间比女性组快约10%（所有P<0.05）。在本研究中，新手在直接喉镜检查和间接喉镜检查期间，男性性别与对上颌切牙施加的较低最大力量相关。需要一项关注气管插管操作中性别差异的临床研究来验证我们的发现。
