本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0762

摘要内容如下：

重要性

通常使用直接喉镜在手术室中插入气管内导管。据报道，视频喉镜检查可改善气道可视化；然而，改进的可视化是否减少了手术患者的插管尝试尚不清楚。

目的

确定使用视频喉镜或直接喉镜进行初次喉镜检查时，每次手术的插管尝试次数是否较低。

设计、设置和参与者

在一家美国学术医院进行的集群随机多交叉临床试验。患者年龄为18岁或以上，接受择期或急诊心脏、胸部或血管外科手术，需要单腔气管插管进行全身麻醉。患者入组时间为2021年3月30日至2022年12月31日。数据分析基于意向治疗。

干预措施

两组共11个手术室在1周的基础上随机进行多角度视频喉镜检查或直接喉镜检查，以进行首次插管尝试。

主要成果和措施

主要结果是每次手术的手术室插管尝试次数。次要结果是插管失败，定义为负责的临床医生在任何时间因任何原因或超过3次插管尝试而改用替代喉镜检查设备，以及气道和牙齿损伤的复合结果。

结果

在7736例患者的8429次手术中，患者年龄中位数为66（IQR，56-73）岁，35%（2950）为女性，85%（7135）为择期手术。随机接受视频喉镜检查的4413例手术中有77例（1.7%）需要1次以上插管尝试，而随机接受直接喉镜检查的4016例手术中有306例（7.6%）需要1次以上插管尝试，插管尝试次数的估计比例优势比为0.20（95%CI，0.14-0.28；P<.001）。使用视频喉镜的4413例手术中有12例（0.27%）发生插管失败，而使用直接喉镜的4016例手术中有161例（4.0%）发生插管失败（相对风险，0.06；95%可信区间为0.03~0.14；P<.001），未经调整的绝对风险差异为-3.7%（95%CI，-4.4%至-3.2%）。在视频喉镜检查（41例损伤[0.93%]）和直接喉镜检查（42例损伤[1.1%]）之间，气道和牙齿损伤没有显著差异。

结论和相关性

在这项研究中，在接受外科手术的成人中，需要单腔气管插管进行全身麻醉，在美国的一个学术医疗中心，与直接喉镜相比，超角度视频喉镜减少了实现气管插管所需的尝试次数。结果表明，对于接受外科手术的插管患者，视频喉镜检查可能是一种更好的方法。

试用注册

ClinicalTrials.gov标识符：NCT04701762。

英文原文如下：

Abstracts

Importance  Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear.

Objective  To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy.

Design, Setting, and Participants  Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat.

Interventions  Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt.

Main Outcomes and Measures  The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries.

Results  Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]).

Conclusion and Relevance  In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures.

Trial Registration  ClinicalTrials.gov Identifier: NCT04701762.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。