比较颈椎固定的成人患者使用视频喉镜和纤维支气管镜进行气管插管的效果：一项随机对照试验的系统评价和荟萃分析。
Comparison of outcomes between video laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in adults with cervical neck immobilization: A systematic review and meta-analysis of randomized controlled trials.
机构信息
Critical Care Medicine, Ordos Central Hospital, Ordos, China.
Anesthesiology Department, Ordos Central Hospital, Ordos, China.
出版信息
PLoS One. 2024 Nov 15;19(11):e0313280. doi: 10.1371/journal.pone.0313280. eCollection 2024.
PURPOSE
Comparing the outcomes of video-laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in patients with cervical spine immobilization.
METHODS
All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 8 Jan 2024 were included. All outcomes were analyzed using Review Manager 5.4. The primary outcomes were the successful first-attempt intubation rate, intubation time, heart rate after intubation, mean arterial pressure after intubation, overall intubation success rate, risk of tissue damage and sore throat.
RESULTS
The meta-analysis included six randomized controlled studies with a total of 694 patients. The outcomes of the meta-analysis revealed that the use of video laryngoscopy was better than flexible fiberoptic bronchoscopy in terms of the successful first-attempt intubation rate (P<0.05) and intubation time (P<0.05) in patients with cervical spine immobilization. However, there were no statistically significant differences in heart rate after intubation, mean arterial pressure after intubation, overall intubation success rate, risk of tissue damage, or sore throat (all P>0.05) between the video laryngoscopy and flexible fiberoptic bronchoscopy groups.
CONCLUSIONS
Compared with flexible fiberoptic bronchoscopy, video laryngoscopy has superior tracheal intubation performance in terms of the first-attempt success rate and intubation speed. This finding was observed in patients with cervical spine immobilization who utilized a cervical collar to simulate a difficult airway. Additionally, both types of scopes demonstrated similar complication rates. Current evidence suggests that video laryngoscopy is better suited than flexible fiberoptic bronchoscopy for endotracheal intubation in patients immobilized with a cervical collar.
TRIAL REGISTRATION
Systematic review protocol: CRD42024499868.
目的
比较颈椎固定患者中视频喉镜与纤维支气管镜行气管插管的效果。
方法
检索 PubMed、Cochrane 图书馆、Medline、Web of Science 和 EMBASE 数据库中截至 2024 年 1 月 8 日发表的所有比较研究。使用 Review Manager 5.4 分析所有结局。主要结局为首次插管成功率、插管时间、插管后心率、插管后平均动脉压、整体插管成功率、组织损伤和咽喉痛风险。
结果
该荟萃分析纳入了 6 项随机对照研究，共 694 例患者。荟萃分析结果显示，颈椎固定患者中，视频喉镜在首次插管成功率（P<0.05）和插管时间（P<0.05）方面优于纤维支气管镜。但两组患者在插管后心率、插管后平均动脉压、整体插管成功率、组织损伤风险和咽喉痛（均 P>0.05）方面差异无统计学意义。
结论
与纤维支气管镜相比，颈椎固定患者使用颈托模拟困难气道时，视频喉镜在首次插管成功率和插管速度方面具有更优的气管插管性能。两种喉镜的并发症发生率相似。现有证据表明，在使用颈托固定的患者中，视频喉镜较纤维支气管镜更适合行气管插管。
试验注册
系统评价方案：CRD42024499868。
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