美国明尼苏达州Hennepin县医疗中心Matthew E. Prekker团队比较了视频喉镜与直接喉镜检查对危重成人患者气管插管成功率的影响。相关论文于2023年6月16日发表在《新英格兰医学杂志》上。

与直接喉镜检查相比，视频喉镜检查是否增加了危重成年人首次尝试成功气管插管的可能性尚不确定。

在一项在17个急诊科和重症监护室（ICU）进行的多中心随机试验中，研究组将接受气管插管的危重成年人随机分配至视频喉镜组或直接喉镜组。主要结局是第一次插管成功。次要结局是插管期间出现严重并发症；严重并发症被定义为严重低氧血症、严重低血压、新的或增加的血管升压药使用、心脏骤停或死亡。

在进行单次预先计划的中期分析时，试验因疗效而停止。在纳入最终分析的1417名患者中（91.5%的患者接受了由急诊住院医师或重症监护人员进行的插管），视频喉镜组705名患者中有600名（85.1%）首次插管成功，直接喉镜组712名患者（70.8%）中有504名（绝对风险差异，14.3个百分点；P<0.001）。视频喉镜组共有151名患者（21.4%）和直接喉镜组共149名患者（20.9%）在插管过程中出现严重并发症（绝对风险差异为0.5个百分点）。两组的安全性结局，包括食道插管、牙齿损伤和抽吸均相似。

研究结果表明，在急诊科或重症监护室接受气管插管的危重成年人中，在第一次尝试时插管时，使用视频喉镜比使用直接喉镜的成功率更高。

附：英文原文

Title: Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults | NEJM

Author: Matthew E. Prekker, M.D., M.P.H.,, Brian E. Driver, M.D.,, Stacy A. Trent, M.D., M.P.H.,, Daniel Resnick-Ault, M.D.,, Kevin P. Seitz, M.D.,, Derek W. Russell, M.D.,, John P. Gaillard, M.D.,, Andrew J. Latimer, M.D.,, Shekhar A. Ghamande, M.D.,, Kevin W. Gibbs, M.D.,, Derek J. Vonderhaar, M.D.,, Micah R. Whitson, M.D.,, Christopher R. Barnes, M.D.,, Jeremy P. Walco, M.D.,, Ivor S. Douglas, M.D.,, Vijay Krishnamoorthy, M.D., Ph.D., M.P.H.,, Alon Dagan, M.D.,, Jill J. Bastman, B.S.N., R.N.,, Bradley D. Lloyd, A.A.S., R.R.T.–A.C.C.S.,, Sheetal Gandotra, M.D.,, Jordan K. Goranson, M.D.,, Steven H. Mitchell, M.D.,, Heath D. White, D.O.,, Jessica A. Palakshappa, M.D.,, Alyssa Espinera, M.D.,, David B. Page, M.D., M.S.P.H.,, Aaron Joffe, D.O.,, Sydney J. Hansen, M.D.,, Christopher G. Hughes, M.D.,, Tobias George, M.S.N., A.C.N.P.,, J. Taylor Herbert, M.D., Ph.D.,, Nathan I. Shapiro, M.D., M.P.H.,, Steven G. Schauer, D.O.,, Brit J. Long, M.D.,, Brant Imhoff, M.S.,, Li Wang, M.S.,, Jillian P. Rhoads, Ph.D.,, Kelsey N. Womack, Ph.D.,, David R. Janz, M.D.,, Wesley H. Self, M.D., M.P.H.,, Todd W. Rice, M.D.,, Adit A. Ginde, M.D., M.P.H.,, Jonathan D. Casey, M.D.,, and Matthew W. Semler, M.D.

Issue&Volume: 2023-06-16

Abstract:

Background

Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain.

Methods

In a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt. The secondary outcome was the occurrence of severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death.

Results

The trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, 3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups.

Conclusions

Among critically ill adults undergoing tracheal intubation in an emergency department or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope.

DOI: 10.1056/NEJMoa2301601

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2301601