视频喉镜检查可能改善危重症患者的插管结局：一项随机对照试验的系统评价和荟萃分析
Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials.
作者信息
Zhang Kai, Zhong Chao, Lou Yuhang, Fan Yushi, Zhen Ningxin, Huang Tiancha, Chen Chengyang, Shan Hui, Du Linlin, Wang Yesong, Cui Wei, Cao Lanxin, Tian Baoping, Zhang Gensheng
机构信息
Department of Critical Care Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China.
Department of Critical Care Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
出版信息
Emerg Med J. 2025 Apr 22;42(5):334-342. doi: 10.1136/emermed-2023-213860.
BACKGROUND
The role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical outcomes of emergency tracheal intubation.
METHODS
We searched the PubMed, Embase, Scopus and Cochrane databases up to 5 September 2024. Randomised controlled trials comparing video laryngoscopy with direct laryngoscopy for emergency tracheal intubation were analysed. The primary outcome was the first-attempt success rate, while secondary outcomes included intubation time, glottic visualisation, in-hospital mortality and complications.
RESULTS
Twenty-six studies (6 in prehospital settings and 20 in hospital settings) involving 5952 patients were analysed in this study. Fifteen studies had low risk of bias. Overall, there was no significant difference in first-attempt success rate between two groups (RR 1.05, 95% CI 0.97 to 1.13, p=0.24, I=89%). However, video laryngoscopy was associated with a higher first-attempt success rate in hospital settings (emergency department: RR 1.13, 95% CI 1.03 to 1.23, p=0.007, I=85%; intensive care unit: RR 1.16, 95% CI 1.05 to 1.29, p=0.003, I=68%) and among inexperienced operators (RR 1.15, 95% CI 1.03 to 1.28, p=0.01, I=72%). Conversely, the first-attempt success rate with video laryngoscopy was lower in prehospital settings (RR 0.75, 95% CI 0.57 to 0.99, p=0.04, I=95%). There were no differences for other outcomes except for better glottic visualisation (RR 1.11, 95% CI 1.03 to 1.20, p=0.005, I=91%) and a lower incidence of oesophageal intubation (RR 0.42, 95% CI 0.24 to 0.71, p=0.001, I=0%) when using video laryngoscopy.
CONCLUSIONS
In hospital settings, video laryngoscopy improved first-attempt success rate of emergency intubation, provided superior glottic visualisation and reduced incidence of oesophageal intubation in critically ill patients. Our findings support the routine use of video laryngoscopy in the emergency department and intensive care units.
PROSPERO REGISTRATION NUMBER
CRD 42023461887.
背景
视频喉镜在需要紧急气管插管的重症患者中的作用仍存在争议。本系统评价和荟萃分析旨在评估视频喉镜是否能改善紧急气管插管的临床结局。
方法
我们检索了截至2024年9月5日的PubMed、Embase、Scopus和Cochrane数据库。分析了比较视频喉镜与直接喉镜用于紧急气管插管的随机对照试验。主要结局是首次尝试成功率，次要结局包括插管时间、声门可视化、院内死亡率和并发症。
结果
本研究分析了26项研究（6项在院前环境中，20项在医院环境中），涉及5952例患者。15项研究的偏倚风险较低。总体而言，两组的首次尝试成功率无显著差异（风险比1.05，95%置信区间0.97至1.13，p=0.24，I²=89%）。然而，在医院环境中（急诊科：风险比1.13，95%置信区间1.03至1.23，p=0.007，I²=85%；重症监护病房：风险比1.16，95%置信区间1.05至1.29，p=0.003，I²=68%）以及经验不足的操作者中（风险比1.15，95%置信区间1.03至1.28，p=0.01，I²=72%），视频喉镜的首次尝试成功率更高。相反，在院前环境中视频喉镜的首次尝试成功率较低（风险比0.75，95%置信区间0.57至0.99，p=0.04，I²=95%）。除了使用视频喉镜时声门可视化更好（风险比1.11，95%置信区间1.03至1.20，p=0.005，I²=91%）和食管插管发生率较低（风险比0.42，95%置信区间0.24至0.71，p=0.001，I²=0%）外，其他结局无差异。
结论
在医院环境中，视频喉镜提高了重症患者紧急插管的首次尝试成功率，提供了更好的声门可视化，并降低了食管插管的发生率。我们的研究结果支持在急诊科和重症监护病房常规使用视频喉镜。
PROSPERO注册号：CRD 42023461887。
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