Department of Anaesthesiology, Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Anaesthesia. 2024 Oct;79(10):1062-1071. doi: 10.1111/anae.16366. Epub 2024 Jul 11.
Although videolaryngoscopy has been proposed as a default technique for tracheal intubation in children, published evidence on universal videolaryngoscopy implementation programmes is scarce. We aimed to determine if universal, first-choice videolaryngoscopy reduces the incidence of restricted glottic views and to determine the diagnostic performance of the Cormack and Lehane classification to discriminate between easy and difficult videolaryngoscopic tracheal intubations in children.
We conducted a prospective observational study within a structured universal videolaryngoscopy implementation programme. We used C-MAC™ (Karl Storz, Tuttlingen, Germany) videolaryngoscopes in all anaesthetised children undergoing elective tracheal intubation for surgical procedures. The direct and videolaryngoscopic glottic views were classified using a six-stage grading system.
There were 904 tracheal intubations in 809 children over a 16-month period. First attempt and overall success occurred in 607 (67%) and 903 (> 99%) tracheal intubations, respectively. Difficult videolaryngoscopic tracheal intubation occurred in 47 (5%) and airway-related adverse events in 42 (5%) tracheal intubations. Direct glottic view during laryngoscopy was restricted in 117 (13%) and the videolaryngoscopic view in 32 (4%) tracheal intubations (p < 0.001). Videolaryngoscopy improved the glottic view in 57/69 (83%) tracheal intubations where the vocal cords were only just visible, and in 44/48 (92%) where the vocal cords were not visible by direct view. The Cormack and Lehane classification discriminated poorly between easy and difficult videolaryngoscopic tracheal intubations with a mean area under the receiver operating characteristic curve of 0.68 (95%CI 0.59-0.78) for the videolaryngoscopic view compared with 0.80 (95%CI 0.73-0.87) for the direct glottic view during laryngoscopy (p = 0.005).
Universal, first-choice videolaryngoscopy reduced substantially the incidence of restricted glottic views. The Cormack and Lehane classification was not a useful tool for grading videolaryngoscopic tracheal intubation in children.
虽然视频喉镜已被提议作为儿童气管插管的首选技术，但关于通用视频喉镜实施计划的已发表证据很少。我们旨在确定通用的首选视频喉镜是否可以降低限制型声门视图的发生率，并确定 Cormack 和 Lehane 分类的诊断性能，以区分儿童中容易和困难的视频喉镜气管插管。
我们在结构化的通用视频喉镜实施计划内进行了前瞻性观察性研究。我们在所有接受择期手术的接受气管插管的麻醉儿童中使用 C-MAC™（Karl Storz，德国图特林根）视频喉镜。直接喉镜和视频喉镜的声门视图使用六级分级系统进行分类。
在 16 个月的时间内，有 809 名儿童中的 904 次气管插管。首次尝试和总体成功率分别为 607 次（67％）和 903 次（>99％）气管插管。47 次（5％）发生困难的视频喉镜气管插管，42 次（5％）发生与气道相关的不良事件。在 117 次（13％）气管插管中限制了直接喉镜检查中的声门视图，在 32 次（4％）气管插管中限制了视频喉镜视图（p <0.001）。在仅能勉强看到声带的 69 次气管插管中有 57 次（83％）和在直接观察无法看到声带的 48 次气管插管中有 44 次（92％）中，视频喉镜改善了声门视图。Cormack 和 Lehane 分类在区分容易和困难的视频喉镜气管插管方面表现不佳，视频喉镜视图的平均受试者工作特征曲线下面积为 0.68（95％CI 0.59-0.78），而喉镜检查中的直接声门视图为 0.80（95％CI 0.73-0.87）（p = 0.005）。
通用的首选视频喉镜大大降低了限制型声门视图的发生率。Cormack 和 Lehane 分类不是用于分级儿童视频喉镜气管插管的有用工具。
