An oropharyngeal device for airway management of conscious and semiconscious patients: A randomized clinical trial.
An oropharyngeal device for airway management of conscious and semiconscious patients: A randomized clinical trial.
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DOI：
10.1002/emp2.12440
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发表时间：
2021-04
影响因子：
2.3
通讯作者：
Bates JHT
中科院分区：
文献类型：
--
作者：
Freeman K;Miller ZD;Herrington RR;Dreyfus NT;Buttaravoli P;Burgess A;Nickerson JP;Daphtary N;Bates JHT
在紧急疏散、转运或复苏期间，没有口咽装置可用于清醒和昏迷的创伤患者。我们的目的是检验ManMaxAirway（MMA）在清醒志愿者中的耐受性优于标准Guedel式器械，以及其产生颌推力并改善气流的假设。这是一项在健康志愿者中使用MMA或标准器械的随机交叉研究。耐受性的主要结局定义为将器械保持在原位60秒。次要结局包括呼吸系统功能和下颌推力。在原位和仅在肺部实验室放置在受试者体内时，测量通过器械管腔的气流阻力。下颌推力被量化为下颌髁突和髁突窝顶点之间相对于磁共振成像（MRI）显示的基线的位移。我们招募了19名受试者。其中，选择5例个体的便利样本进行MRI;其余个体（n = 14）随机分配进行交叉研究。所有14例受试者均能够维持MMA 60秒，而使用标准器械的受试者为2/14（14%）（比值比，145; 95%置信区间，6.3 - 3314）。受试者报告说，实验装置更舒适，其放置不会引发呕吐反射。MMA在振荡流模型中产生的气道阻力比标准器械低近一个数量级（实验与标准，8 Hz-0.092 vs 0.786 cmH 20·s/L; 15 Hz-0.193 vs 1.321 cmH 20·s/L）。快速诱导呕吐反射排除了使用标准装置进行进一步测量。在有和没有MMA的清醒志愿者中进行的强迫振荡肺测试表明，该装置降低了呼吸系统对气流的阻力和呼吸弹性（分别为31% ± 8%和44% ± 13.4%; P < 0.05）。MMA就位的受试者（n = 5）的MRI显示与基线相比（7 ± 1 mm）有显著的颌推力。MMA被证明在清醒的受试者中耐受性良好，导致解剖气道开放和气流阻力降低。
No oropharyngeal devices exist for use in conscious and semiconscious trauma patients during emergency evacuation, transport, or resuscitation. We aimed to test the hypotheses that the ManMaxAirway (MMA) is better tolerated than the standard Guedel‐style device in awake volunteers and that it produces a jaw thrust and improves air flow. This was a randomized cross‐over study of healthy volunteers with either the MMA or standard device. The primary outcome of tolerability was defined as maintaining the device in place for 60 seconds. Secondary outcomes included respiratory system function and jaw thrust. Resistance to airflow through the device lumen was measured in situ and when placed in subjects in the pulmonary laboratory alone. Jaw thrust was quantified as displacement between the mandibular condyle and condylar fossa apex relative to baseline visualized with magnetic resonance imaging (MRI). We enrolled 19 subjects. Of these, a convenience sample of 5 individuals was selected for MRI; the remaining individuals (n = 14) were randomized for the cross‐over study. All 14 subjects were able to maintain the MMA for 60 seconds compared with 2/14 (14%) with the standard device (odds ratio, 145; 95% confidence interval, 6.3‐3314). Subjects reported that the experimental device was more comfortable and its placement did not trigger the gag reflex. Airway resistance produced by the MMA in an oscillatory flow model was nearly an order of magnitude lower than that of the standard device (experimental vs standard, 8 Hz—0.092 vs 0.786 cmH20·s/L; 15 Hz—0.193 vs 1.321 cmH20·s/L). Rapid induction of the gag reflex precluded further measurements with the standard device. Forced oscillation pulmonary testing in conscious volunteers with and without the MMA demonstrated that the device decreased respiratory system resistance to airflow and reduced respiratory elastance (31% ± 8% and 44% ± 13.4%, respectively; P < 0.05). MRIs of the subjects (n = 5) with the MMA in place showed a significant jaw thrust compared with baseline (7 ± 1 mm). The MMA proved well tolerated in conscious subjects, resulting in an opening of the anatomic airway and a decreased resistance to airflow.