Xu Wenyun, Zhu Chenglong, Wu Qinghua, Zhao Bin, Zhou Miao, Liu Yang, Hu Yongchu, Xia Jianhua, Yuan Hongbin, Yu Yaohua, Zou Zui
School of Anesthesiology, Naval Medical University, Shanghai, 200433, China.
Department of Anesthesiology, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
BMC Anesthesiol. 2025 Jul 29;25(1):360. doi: 10.1186/s12871-025-03229-1.
Fibreoptic bronchoscope (FOB) is considered complex to learn and operate, and it remains controversial whether videolaryngoscopy can be used as an alternative to FOB for awake tracheal intubation (ATI).
The Objective is to compare the effectiveness of Safe Easy Endotracheal kit-flexible (SEEK)/video laryngoscopy and FOB in ATI.
We conducted a pragmatic, multicentre, non-blinded, randomized, parallel-group clinical trial in Shanghai and Putian, China. Between January 2023 and June 2024, patients aged 18-80 years who required ATI and were able to adapt to videolaryngoscopy were enrolled. We randomly assigned 148 patients who received ATI to two groups in a 1:1 ratio: SEEK/videolaryngoscopy group and FOB group. The rate of successful intubation at the first attempt was the primary outcome. Secondary endpoints were time to tracheal intubation; patient-reported satisfaction with the technique; and complications arising from intubation.
Successful intubation at the first attempt was achieved in 69 cases (93%) using SEEK /videolaryngoscopy and only 58 cases (80%) using FOB, p = 0.015. The median (IQR [range]) time to tracheal intubation was 59 (51-66 [29-150]) s in the SEEK/videolaryngoscopy group and 92 (77-157 [40-869]) s in the FOB group, p < 0.001. The median (IQR [range]) scores for patient satisfaction were 8 (7-9 [4-10]) and 6 (4-7 [1-10]) in the SEEK/videolaryngoscopy group and the FOB group, respectively, p < 0.001. SEEK/videolaryngoscopy attenuated the incidence of postintubation complications.
SEEK/videolaryngoscopy can be used as an alternative to FOB in clinical practice when ATI is required due to the high rate of successful intubation at the first attempt, short intubation time, low complication rate and high patient satisfaction scores.
ChiCTR2300067555, 01/11/2023.
纤维支气管镜（FOB）被认为学习和操作复杂，对于视频喉镜能否作为清醒气管插管（ATI）时FOB的替代方法仍存在争议。
比较Safe Easy Endotracheal kit-flexible（SEEK）/视频喉镜和FOB在ATI中的有效性。
我们在中国上海和莆田进行了一项实用、多中心、非盲、随机、平行组临床试验。在2023年1月至2024年6月期间，纳入年龄在18 - 80岁、需要ATI且能够适应视频喉镜检查的患者。我们将148例接受ATI的患者按1:1比例随机分为两组：SEEK/视频喉镜组和FOB组。首次尝试气管插管的成功率是主要结局指标。次要终点包括气管插管时间；患者对该技术的满意度；以及插管引起的并发症。
使用SEEK/视频喉镜首次尝试气管插管成功69例（93%），而使用FOB仅58例（80%），p = 0.015。SEEK/视频喉镜组气管插管的中位（IQR[范围]）时间为59（51 - 66[29 - 150]）秒，FOB组为92（77 - 157[40 - 869]）秒，p < 0.001。SEEK/视频喉镜组和FOB组患者满意度的中位（IQR[范围]）评分分别为8（7 - 9[4 - 10]）和6（4 - 7[1 - 10]），p < 0.001。SEEK/视频喉镜降低了插管后并发症的发生率。
当因首次尝试插管成功率高、插管时间短、并发症发生率低和患者满意度评分高而需要进行ATI时，SEEK/视频喉镜可在临床实践中作为FOB的替代方法。
ChiCTR2300067555，2023年11月1日。
