Cheng Kai-Yuan, Liu Pang Hsu, Su Yung-Cheng, Chen Yen-Yu, Yeh Ya-Ni, Lin Jih-Chun, Tsai Ming-Jen
Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Road, East District, Chiayi City, 600, Taiwan.
BMC Emerg Med. 2024 Dec 18;24(1):236. doi: 10.1186/s12873-024-01148-x.
In emergency settings, difficult intubations often occur unexpectedly despite pre-intubation assessments. Traditional glottic view scoring systems for direct laryngoscope may not apply to video laryngoscopy. With video laryngoscopy, the vertical location of the glottis on the monitor can be clearly defined. If the glottis location is associated with intubation difficulty, it could serve as a simple indicator for anticipating intubation challenges. This study aimed to investigate the relationship between the glottis screen location during video laryngoscopy-guided intubation and the success and timing of the first-attempt intubation.
We retrospectively analyzed laryngoscopy recordings from adult intubations in the emergency department of a tertiary teaching hospital in Chiayi, Taiwan, using the C-MAC video laryngoscope between March 2020 and April 2023. The vertical screen location of the vocal cords, determined by the arytenoid cartilage position after laryngeal blade engagement, was categorized into upper and lower locations for analysis. The primary outcome was first-attempt intubation success within 90 s, analyzed using Kaplan-Meier survival curves and multivariable Cox proportional hazard analysis.
Among 209 laryngoscopy records, 113 had the arytenoid in the lower field of view and 96 in the upper field. Kaplan-Meier analysis showed a significantly lower cumulative success rate for intubations with a higher arytenoid location (log-rank test, P < 0.001). Multivariable Cox models, adjusted for factors like modified Cormack-Lehane grade, blade tip engagement, and other intubation findings, confirmed the arytenoid's location as an independent predictor of successful intubation within 90 s, with an adjusted hazard ratio of 0.55 (95% confidence interval, 0.38-0.79) for the upper location group compared to the lower (P < 0.001).
A higher screen location of the vocal cords after blade engagement is associated with reduced first-attempt intubation success. Assessing glottis location during video laryngoscopy intubation provides a quick method to anticipate intubation challenges.
在急诊环境中，尽管进行了插管前评估，但困难插管仍常常意外发生。传统的直接喉镜声门视图评分系统可能不适用于视频喉镜。使用视频喉镜时，声门在监视器上的垂直位置可以清晰界定。如果声门位置与插管困难相关，它可作为预测插管挑战的一个简单指标。本研究旨在探讨视频喉镜引导插管期间声门在屏幕上的位置与首次尝试插管的成功率及时间之间的关系。
我们回顾性分析了2020年3月至2023年4月间台湾嘉义一家三级教学医院急诊科使用C-MAC视频喉镜对成人进行插管的喉镜记录。根据喉镜片插入后杓状软骨的位置确定声带在屏幕上的垂直位置，分为上、下位置进行分析。主要结局是在90秒内首次尝试插管成功，使用Kaplan-Meier生存曲线和多变量Cox比例风险分析进行分析。
在209份喉镜记录中，113份记录的杓状软骨位于视野下方，96份位于视野上方。Kaplan-Meier分析显示，杓状软骨位置较高时插管的累积成功率显著较低（对数秩检验，P < 0.001）。多变量Cox模型在调整了改良Cormack-Lehane分级、镜片尖端插入情况及其他插管结果等因素后，证实杓状软骨位置是90秒内插管成功的独立预测因素，与下方位置组相比，上方位置组的调整后风险比为0.55（95%置信区间，0.38 - 0.79）（P < 0.001）。
镜片插入后声带在屏幕上的位置较高与首次尝试插管成功率降低相关。在视频喉镜插管期间评估声门位置可提供一种预测插管挑战的快速方法。
