Karabacak Ali Rıza, Özturan İbrahim Ulaş, Şefoğlu Ömer Faruk, Doğan Nurettin Özgür, Yaka Elif, Yılmaz Serkan, Pekdemir Murat
Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye.
Department of Medical Education, Institute of Health Sciences, Acibadem University, Istanbul, Türkiye.
Turk J Emerg Med. 2024 Jul 1;24(3):151-157. doi: 10.4103/tjem.tjem_18_24. eCollection 2024 Jul-Sep.
This study aimed to compare the effects of Macintosh-type and hyperangulated video laryngoscopy (VL) blades on dental force during endotracheal intubation (ETI) using Glidescope and McGrath VL devices.
In this randomized, crossover, manikin study conducted at a university emergency medicine (EM) program, 65 EM trainees included interns and residents performed 520 intubations using four different VL blades (GlideScope VL with Macintosh-type Mac T3 and hyperangular Lo Pro T3 blades and McGrath VL Macintosh-type MAC 4 and hyperangular McGrath X3 blades) in normal and difficult airway scenarios. The primary outcome of this study was the dental pressure (Newton) exerted during ETI. The secondary outcomes included c-spine motion (degree), intubation success (%), duration (seconds), successful glottic view (%), and intubator comfort (7-point Likert).
Significant differences were observed in dental force (H(3) = 11.7, = 0.008), c-spine motion (H(3) = 8.34, = 0.039), duration (H(3) = 16.56, = 0.001), and comfort (H(3) = 174.96, < 0.001) across blade types. Glidescope LoPro T3 provided a significant lower dental force (adjusted = 0.01), less c-spine motion (adjusted = 0.031), and shorter intubation duration (adj < 0.01) than the McGrath Mac 4. First attempt success and intubator comfort were significantly better with all Glidescope blades (z score of 3.7 and 4.7) than with McGrath blades (z score of-4.1 and-4.4).
The Glidescope LoPro T3 blade demonstrated advantages in dental force, c-spine motion, and intubation duration compared with McGrath Mac 4. Overall, the Glidescope blades provided superior comfort and higher first attempt success rates.
本研究旨在比较使用Glidescope和McGrath可视喉镜设备进行气管插管（ETI）时，Macintosh型和角度加大的可视喉镜（VL）叶片对牙齿受力的影响。
在一所大学急诊医学（EM）项目中进行的这项随机、交叉、人体模型研究中，65名EM实习生（包括实习医生和住院医生）在正常和困难气道情况下，使用四种不同的VL叶片（带有Macintosh型Mac T3和角度加大的Lo Pro T3叶片的GlideScope VL以及Macintosh型MAC 4和角度加大的McGrath X3叶片的McGrath VL）进行了520次插管。本研究的主要结果是ETI期间施加的牙齿压力（牛顿）。次要结果包括颈椎活动度（度）、插管成功率（%）、持续时间（秒）、声门直视成功率（%）和插管者舒适度（7分李克特量表）。
不同类型叶片在牙齿受力（H(3)=11.7，P = 0.008）、颈椎活动度（H(3)=8.34，P = 0.039）、持续时间（H(3)=16.56，P = 0.001）和舒适度（H(3)=174.96，P < 0.001）方面存在显著差异。与McGrath Mac 4相比，GlideScope LoPro T3产生的牙齿受力显著更低（校正P = 0.01），颈椎活动度更小（校正P = 0.031），插管持续时间更短（校正P < 0.01）。所有GlideScope叶片的首次尝试成功率和插管者舒适度（z评分为3.7和4.7）均显著优于McGrath叶片（z评分为 -4.1和 -4.4）。
与McGrath Mac 4相比，GlideScope LoPro T3叶片在牙齿受力、颈椎活动度和插管持续时间方面具有优势。总体而言，GlideScope叶片提供了更高的舒适度和首次尝试成功率。
