Ratajczyk Pawel, Kluj Przemyslaw, Wasiak Krzysztof, Strzalek Jeremi, Kolodziejska Karolina, Gaszynski Tomasz
Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland.
II Department of Cardiology, Central University Hospital, Medical University of Lodz, Lodz, Poland.
Adv Med Educ Pract. 2024 Dec 25;15:1299-1312. doi: 10.2147/AMEP.S486331. eCollection 2024.
Videolaryngoscopes increased the safety of patients requiring endotracheal intubation. Their particular beneficiaries are healthcare providers inexperienced in intubation. We compared the learning curve of McGrath, UESCOPE, and Airtraq VLs among the first-year anesthesiology residents.
Sixteen residents were qualified for the study, none of whom has ever before used any VL nor had any experience with the Macintosh laryngoscope. The study was conducted during anesthesia without anticipated intubation difficulties and included 288 adult patients with BMI <25 and ASA ≤ II, without visible intubation difficulties. It was a randomized, controlled, and blinded crossover study. Each resident performed six intubations with a given VL in randomized order.
There were no statistically significant differences in patient characteristics. In McGrath there was observed significant improvement of intubation time, confirmed intubation time, ease, POGO scale, effective intubation, thyroid pressure application, and intubation trauma. Intubation efficacy increased from 12 (75%) at first attempt, to 16 (100%) during third and following attempts. Residents used pressure 6 times (38%) during first attempt and 7 times (44%) during second attempt, and 1 (6%) at last attempt. McGrath traumatism was noticed in 4 (25%) patients at first two attempts, none during third and following attempts. In Airtraq, we observed a significant improvement of intubation time, time of confirmed intubation, force used, ease, effective intubation, and application of pressure to thyroid cartilage. Intubation efficacy increased from 10 (62%) during the first to 16 (100%) during the following attempts. Thyroid pressure was applied 7 times (44%) during first intubation and 0 times during the last two attempts. In the case of UESCOPE VL, we observed a significant improvement of intubation time, time of confirmed intubation, force used, and ease.
Results demonstrated that Airtraq VL having the best learning curve, and UESCOPE having the best first-time use. The results require confirmation in a larger study group. This study was approved on 14 November 2023 by the Medical University of Lodz Bioethics Committee (ref: RNN/160/23/KE).
视频喉镜提高了需要气管插管患者的安全性。其特定受益者是插管经验不足的医护人员。我们比较了麦格拉斯喉镜、UEESCOPE喉镜和Airtraq喉镜在第一年麻醉住院医师中的学习曲线。
16名住院医师符合研究条件，他们之前均未使用过任何视频喉镜，也没有使用麦金托什喉镜的经验。该研究在无预期插管困难的麻醉过程中进行，纳入288例体重指数<25且美国麻醉医师协会身体状况分级≤II级、无明显插管困难的成年患者。这是一项随机、对照、双盲交叉研究。每位住院医师按随机顺序使用一种特定的视频喉镜进行6次插管。
患者特征方面无统计学显著差异。在使用麦格拉斯喉镜时，观察到插管时间、确认插管时间、操作 ease、POGO评分、有效插管、甲状腺施压及插管创伤均有显著改善。首次尝试时插管成功率为12例（75%），第三次及后续尝试时为16例（100%）。住院医师首次尝试时施压6次（38%），第二次尝试时施压7次（44%），最后一次尝试时施压1次（6%）。在前两次尝试中有4例（25%）患者出现麦格拉斯喉镜创伤，第三次及后续尝试中无创伤发生。在使用Airtraq喉镜时，观察到插管时间、确认插管时间、用力程度、操作 ease、有效插管及甲状腺软骨施压均有显著改善。首次尝试时插管成功率为10例（62%），后续尝试时为16例（100%）。首次插管时甲状腺施压7次（44%）,最后两次尝试时未施压。在使用UEESCOPE视频喉镜时，观察到插管时间、确认插管时间、用力程度及操作 ease均有显著改善。
结果表明，Airtraq喉镜学习曲线最佳，UEESCOPE喉镜首次使用效果最佳。结果需要在更大的研究组中得到证实。本研究于2023年11月14日获得罗兹医科大学生物伦理委员会批准（编号：RNN/160/23/KE）。
