本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMoa2402785

摘要内容如下：

背景

反复尝试气管插管与新生儿不良事件增加有关。当临床医生用喉镜直接观察气道时，只有不到一半的首次尝试是成功的。在成人和儿童中，与使用直接喉镜相比，使用视频喉镜（其在叶片的尖端具有在屏幕上显示气道视图的摄像机）与第一次尝试成功插管的百分比更高有关。视频喉镜检查在新生儿中的效果尚不确定。

方法

在这项单中心试验中，我们将在产房或新生儿重症监护室（NICU）接受插管的任何胎龄的新生儿随机分配到视频喉镜组或直接喉镜组。根据胎龄（<32周或≥32周）进行随机分层。主要结果是第一次尝试成功插管，通过呼出二氧化碳检测确定。

结果

对参加试验的226名新生儿中的214名进行了数据分析，其中63名（29%）在产房插管，151名（71%）在NICU插管。107例患者中79例（74%）一次插管成功；95%可信区间[CI]，66-82），107名患者中有48名（45%；95%CI，35至54）（P<0.001）。视频喉镜组成功插管的平均尝试次数为1次（95%CI，1:1），直接喉镜组为2次（95%CI，1:2）。插管期间最低血氧饱和度的中位数在视频喉镜组为74%（95%CI，65-78），在直接喉镜组为68%（95%CI，62-74）；最低心率分别为每分钟153次（95%CI，148至158）和148次（95%CI，140至156）。

结论

在接受紧急气管插管的新生儿中，视频喉镜比直接喉镜导致更多的首次尝试成功插管。（由国家妇产医院基金会资助；Vode ClinicalTrials.gov编号，NCT04994652。）

英文原文如下：

Abstracts

BACKGROUND  Repeated attempts at endotracheal intubation are associated with increased adverse events in neonates. When clinicians view the airway directly with a laryngoscope, fewer than half of first attempts are successful. The use of a video laryngoscope, which has a camera at the tip of the blade that displays a view of the airway on a screen, has been associated with a greater percentage of successful intubations on the first attempt than the use of direct laryngoscopy in adults and children. The effect of video laryngoscopy among neonates is uncertain.

METHODS  In this single-center trial, we randomly assigned neonates of any gestational age who were undergoing intubation in the delivery room or neonatal intensive care unit (NICU) to the video-laryngoscopy group or the direct-laryngoscopy group. Randomization was stratified according to gestational age (<32 weeks or ≥32 weeks). The primary outcome was successful intubation on the first attempt, as determined by exhaled carbon dioxide detection.

RESULTS  Data were analyzed for 214 of the 226 neonates who were enrolled in the trial, 63 (29%) of whom were intubated in the delivery room and 151 (71%) in the NICU. Successful intubation on the first attempt occurred in 79 of the 107 patients (74%; 95% confidence interval [CI], 66 to 82) in the video-laryngoscopy group and in 48 of the 107 patients (45%; 95% CI, 35 to 54) in the direct-laryngoscopy group (P<0.001). The median number of attempts to achieve successful intubation was 1 (95% CI, 1 to 1) in the video-laryngoscopy group and 2 (95% CI, 1 to 2) in the direct-laryngoscopy group. The median lowest oxygen saturation during intubation was 74% (95% CI, 65 to 78) in the video-laryngoscopy group and 68% (95% CI, 62 to 74) in the direct-laryngoscopy group; the lowest heart rate was 153 beats per minute (95% CI, 148 to 158) and 148 (95% CI, 140 to 156), respectively.

CONCLUSIONS  Among neonates undergoing urgent endotracheal intubation, video laryngoscopy resulted in a greater number of successful intubations on the first attempt than direct laryngoscopy. (Funded by the National Maternity Hospital Foundation; VODE ClinicalTrials.gov number, NCT04994652.).

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