现在的位置: 首页时讯速递, 进展交流>正文
[JAMA在线发表]:可视喉镜与直接喉镜用于ICU患者经口气管插管首次成功率的随机对照研究
2017年02月19日 时讯速递, 进展交流 暂无评论

JAMA | Original Investigation | CARING FOR THE CRITICALLY ILL PATIENT

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients: A Randomized Clinical Trial

Jean Baptiste Lascarrou, Julie Boisrame-Helms, Arthur Bailly, et al.

JAMA. doi:10.1001/jama.2016.20603

Published online January 24, 2017.

IMPORTANCE 背景

In the intensive care unit (ICU), orotracheal intubation can be associated with increased risk of complications because the patient may be acutely unstable, requiring prompt intervention, often by a practitioner with nonexpert skills. Video laryngoscopy may decrease this risk by improving glottis visualization.

ICU中的经口气管插管伴随并发症风险增加,因为患者病情不稳定,需要立即采取治疗措施,且医生通常缺乏丰富的专科经验。可视喉镜通过直视会厌可能减少上述风险。

OBJECTIVE 目的

To determine whether video laryngoscopy increases the frequency of successful first-pass orotracheal intubation compared with direct laryngoscopy in ICU patients.

确定与直接喉镜相比,可视喉镜能否增加ICU患者经口气管插管首次成功率。

DESIGN, SETTING, AND PARTICIPANTS 设计,场景及患者

Randomized clinical trial of 371 adults requiring intubation while being treated at 7 ICUs in France between May 2015 and January 2016; there was 28 days of follow-up.

2015年5月至2016年1月期间,在法国7个ICU中进行的随机临床试验。研究对象为需要气管插管的371名成年患者,随访期28天。

INTERVENTIONS 干预措施

Intubation using a video laryngoscope (n = 186) or direct laryngoscopy (n = 185). All patients received general anesthesia.

采用可视喉镜(n = 186)或直接喉镜(n = 185)进行气管插管。所有患者均接受全麻。

MAIN OUTCOMES AND MEASURES 主要预后指标

The primary outcome was the proportion of patients with successful first-pass intubation. The secondary outcomes included time to successful intubation and mild to moderate and severe life-threatening complications.

主要预后指标为首次插管成功率。次要预后指标包括至成功插管所需时间,轻、中及重度致命性并发症。

RESULTS 结果

Among 371 randomized patients (mean [SD] age, 62.8 [15.8] years; 136 [36.7%] women), 371 completed the trial. The proportion of patients with successful first-pass intubation did not differ significantly between the video laryngoscopy and direct laryngoscopy groups (67.7%vs 70.3%; absolute difference, −2.5%[95%CI, −11.9%to 6.9%]; P = .60). The proportion of first-attempt intubations performed by nonexperts (primarily residents, n = 290) did not differ between the groups (84.4%with video laryngoscopy vs 83.2%with direct laryngoscopy; absolute difference 1.2%[95%CI, −6.3%to 8.6%]; P = .76). The median time to successful intubation was 3 minutes (range, 2 to 4 minutes) for both video laryngoscopy and direct laryngoscopy (absolute difference, 0 [95%CI, 0 to 0]; P = .95). Video laryngoscopywas not associated with life-threatening complications (24/180 [13.3%] vs 17/179 [9.5%] for direct laryngoscopy; absolute difference, 3.8% [95%CI, −2.7%to 10.4%]; P = .25). In post hoc analysis, video laryngoscopywas associated with severe life-threatening complications (17/179 [9.5%] vs 5/179 [2.8%] for direct laryngoscopy; absolute difference, 6.7%[95%CI, 1.8%to 11.6%]; P = .01) but not with mild to moderate life-threatening complications (10/181 [5.4%] vs 14/181 [7.7%]; absolute difference, −2.3%[95%CI, −7.4%to 2.8%]; P = .37).

总共371 名患者接受随机分组(平均 [SD] 年龄,62.8 [15.8] 岁;136 [36.7%] 名女性),371 名患者完成试验。可视喉镜组与直接喉镜组首次插管成功率无显著差异 (67.7% vs 70.3%;绝对差异−2.5%[95%CI, −11.9% - 6.9%]; P = .60)。非专科医生(主要为住院医师,n = 290)进行首次插管的比例并无差异(可视喉镜组 84.4% vs 直接喉镜组83.2%;绝对差异 1.2% [95%CI, −6.3% - 8.6%]; P = .76)。两组至成功插管所需时间中位数均为3 分钟(范围,2 - 4 分钟)(绝对差异 0 [95%CI, 0 - 0]; P = .95)。可视喉镜组致命性并发症并不增加(24/180 [13.3%] vs 直接喉镜组 17/179 [9.5%];绝对差异 3.8% [95%CI, −2.7% -10.4%]; P = .25)。在事后分析中,可视喉镜组严重致命性并发症增加(17/179 [9.5%] vs 直接喉镜组 5/179 [2.8%];绝对差异 6.7% [95%CI, 1.8% - 11.6%]; P = .01),但轻中度致命性并发症并无差异(10/181 [5.4%] vs 14/181 [7.7%];绝对差异,−2.3% [95%CI, −7.4% - 2.8%]; P = .37)。

CONCLUSIONS AND RELEVANCE 结论与意义

Among patients in the ICU requiring intubation, video laryngoscopy compared with direct laryngoscopy did not improve first-pass orotracheal intubation rates and was associated with higher rates of severe life-threatening complications. Further studies are needed to assess the comparative effectiveness of these 2 strategies in different clinical settings and among operators with diverse skill levels.

对于需要气管插管的ICU患者,与直接喉镜相比,可视喉镜不能改善首次插管成功率,且伴随严重致命性并发症发生率增加。需要进一步研究评估这两种方法在不同临床情况下以及能力不同操作者的效果。

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02413723

 

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博