Dallyn Benjamin, Hanratty Ronan, Hillier Matthew, Ainsworth Matthew, Hansel Jan, Cook Tim M
Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
Acute Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, UK.
Anaesthesia. 2025 Sep;80(9):1074-1082. doi: 10.1111/anae.16632. Epub 2025 May 27.
Tracheal tube introducers facilitate tracheal intubation and include stylets and static/dynamic bougies. There is uncertainty over the most efficacious introducer with hyperangulated videolaryngoscopy.
We evaluated five introducers. Thirty anaesthetists intubated a manikin 10 times with a reusable C-MAC® D-blade videolaryngoscope using five introducers in two airway setups. Airway setup was allocated randomly to standard or difficult tracheal intubation and the order of use of five introducers: two stylets (C-MAC Stylet; Universal Stylet Bougie™); two dynamic bougies (Total Control Introducer™; Steerable Tracheal Intubation Guide™); and a static bougie (Portex® Bougie). The primary outcome was first-attempt tracheal intubation success. Secondary outcomes were tracheal intubation within 120 seconds; time to tracheal intubation; and operator-rated ease of tracheal intubation, railroading and force required.
With the standard tracheal intubation setup, first-attempt tracheal intubation success rates (95%CI) were: C-MAC Stylet 100% (100-100%); Universal Stylet Bougie 93% (84-100%); Total Control Introducer 90% (79-100%); Steerable Tracheal Intubation Guide 80% (65-95%); and Portex bougie 57% (37-76%). With the difficult tracheal intubation setup, first-attempt tracheal intubation success rates (95%CI) were: C-MAC Stylet 93% (84-100%); Total Control Introducer 87% (74-99%); Universal Stylet Bougie 73% (56-90%); Steerable Tracheal Intubation Guide 60% (41-79%); and Portex bougie 33% (15-51%). The C-MAC Stylet was best and the static bougie worst across all outcomes, with differences greater when tracheal intubation was designed to be difficult. In pairwise comparisons of tracheal intubation first-attempt success in the difficult airway, the C-MAC Stylet, Universal Stylet Bougie and Total Control Introducer were statistically significantly better than the Portex Bougie; the C-MAC stylet was also statistically significantly better than the Steerable Tracheal Intubation Guide.
Among introducers for hyperangulated videolaryngoscopy, stylets were most efficacious and a static bougie least. Differences in performance increased when tracheal intubation was difficult.
气管导管导入器有助于气管插管，包括管芯和静态/动态探条。对于角度极度弯曲的视频喉镜，哪种导入器最有效尚无定论。
我们评估了五种导入器。30名麻醉医生在两种气道设置下使用五种导入器，用可重复使用的C-MAC® D型叶片视频喉镜对人体模型进行10次插管操作。气道设置随机分配为标准或困难气管插管，以及五种导入器的使用顺序：两种管芯（C-MAC管芯；通用管芯探条™）；两种动态探条（全控导入器™；可转向气管插管引导器™）；以及一种静态探条（Portex®探条）。主要结局是首次尝试气管插管成功。次要结局包括120秒内气管插管成功；气管插管时间；以及操作者评定的气管插管难易程度、套入操作和所需力量。
在标准气管插管设置下，首次尝试气管插管成功率（95%CI）分别为：C-MAC管芯100%（100-100%）；通用管芯探条93%（84-100%）；全控导入器90%（79-100%）；可转向气管插管引导器80%（65-95%）；以及Portex探条57%（37-76%）。在困难气管插管设置下，首次尝试气管插管成功率（95%CI）分别为：C-MAC管芯93%（84-100%）；全控导入器87%（74-99%）；通用管芯探条73%（56-90%）；可转向气管插管引导器60%（41-79%）；以及Portex探条33%（15-51%）。在所有结局方面，C-MAC管芯最佳，静态探条最差，当气管插管设计为困难时差异更大。在困难气道中气管插管首次尝试成功率的两两比较中，C-MAC管芯、通用管芯探条和全控导入器在统计学上显著优于Portex探条；C-MAC管芯在统计学上也显著优于可转向气管插管引导器。
在角度极度弯曲的视频喉镜导入器中，管芯最有效，静态探条最无效。当气管插管困难时，性能差异会增大。
