Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
Anaesthesia. 2024 Oct;79(10):1091-1101. doi: 10.1111/anae.16379. Epub 2024 Jul 28.
Tracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer-associated airway trauma.
PubMed, EMBASE and CINAHL databases were searched using pre-determined criteria. Two authors independently assessed search results and performed data extraction and risk of bias assessments.
We included 16 randomised controlled trials and five observational studies involving 10,797 patients. There was heterogeneity in patient characteristics, airway manipulation, and airway trauma definition and measurement. One study investigated hyperangulated videolaryngoscopy. The standard stylet was the most commonly reported introducer, followed by bougie and stylets with additional features such as video or lighted tip. Airway trauma resulted in low harm and most frequently involved injuries to the upper airway, followed by laryngeal and tracheobronchial injuries. Eighteen studies were comparative and reported a reduction in airway trauma incidence when an introducer was used, with the exception of the standard stylet. Median (IQR [range]) pooled incidence of airway trauma associated with standard stylets was 13.1% (4.2-31.4 [0.5-79.2])% and with bougies was 5.4% (0.4-49.9 [0.0-68.0])%. The risk of bias of included studies was variable and many randomised trials were found to be at high risk due to non-robust measurement of the outcome.
Stylets might be associated with an increased risk of airway trauma compared with other devices or when no stylet was used, though the quality of evidence is modest. However, other introducers appear to be safe and reduce the risk of airway trauma.
气管导管导引器在气道管理指南中被推荐使用，并且随着可视喉镜的广泛应用，其使用也越来越多。本系统评价旨在总结关于气管导管导引器相关气道创伤的已发表文献。
使用预先确定的标准，在 PubMed、EMBASE 和 CINAHL 数据库中进行检索。两位作者独立评估检索结果，并进行数据提取和偏倚风险评估。
我们纳入了 16 项随机对照试验和 5 项观察性研究，涉及 10797 名患者。患者特征、气道操作以及气道创伤的定义和测量存在异质性。有一项研究调查了高角度可视喉镜。标准管芯是最常报道的导引器，其次是气管插管和带有附加功能（如视频或带光尖）的管芯。气道创伤导致的伤害程度较低，最常涉及上呼吸道损伤，其次是喉和气管支气管损伤。18 项研究是比较性的，报告使用导引器可降低气道创伤的发生率，但标准管芯除外。标准管芯相关气道创伤的发生率中位数（IQR [范围]）为 13.1%（4.2-31.4 [0.5-79.2]）%，而与气管插管相关的发生率为 5.4%（0.4-49.9 [0.0-68.0]）%。纳入研究的偏倚风险各不相同，许多随机试验由于对结果的非稳健测量而被认为具有高偏倚风险。
与其他设备或不使用管芯相比，管芯可能与气道创伤风险增加相关，尽管证据质量中等。然而，其他导引器似乎是安全的，可以降低气道创伤的风险。
