Trend and Outcomes of Video Laryngoscope Use Across PICUs
Trend and Outcomes of Video Laryngoscope Use Across PICUs
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DOI：
10.1097/pcc.0000000000001175
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发表时间：
2017-08-01
影响因子：
4.1
通讯作者：
Nishisaki, Akira
中科院分区：
文献类型：
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作者：
Grunwell, Jocelyn R.;Kamat, Pradip P.;Nishisaki, Akira
目的：视频（间接）喉镜在急诊科和成人ICU中用作困难气道的主要气管插管器械。与直接喉镜相比，视频喉镜的使用和结果尚未在PICU或心脏ICU中量化。设计：回顾性分析从多中心气管插管数据库中前瞻性收集的观察数据（国家儿童紧急气道登记处），2010年7月至2015年6月。美国、加拿大、日本、新西兰和新加坡的36个PICU/心脏ICU。患者：入住PICU或儿科心脏ICU并接受气管插管的任何患者。干预措施：直接喉镜与视频喉镜在气管插管中的应用。测量和主要结果：在国家儿童紧急气道登记数据库中报告了8,875例气管插管，包括7例，947例（89.5%）使用直接喉镜进行气管插管，928例（10.5%）使用视频喉镜进行气管插管。在PICU中，视频喉镜的使用存在很大的差异（中位数，2.6%;范围，0-55%）。视频喉镜更常用于年龄较大的儿童（p < 0.001），有困难气道病史的儿童（p = 0.01），因呼吸衰竭而插管的儿童（p < 0.001），以及促进完成择期手术（p = 0.048）。在调整患者水平协变量、长期趋势和研究中心水平方差后，与2011财年相比，视频喉镜的使用在5年内显著增加（2014财年的比值比为6.7; 95%CI为1.7-26.8，2015财年的比值比为11.2; 95%CI为3.2-38.9）。使用视频喉镜与气管插管不良事件发生率较低独立相关（校正比值比，0.57; 95%CI，0.42-0.77; p < 0.001），但严重气管插管不良事件的发生率并没有降低（调整的比值比，0.86; 95% CI，0.56-1.32; p = 0.49）或更少的多次气管插管尝试（调整的比值比，0.93; 95%CI，0.71-1.22; p = 0.59）。使用国家儿童紧急气道登记处的数据，我们描述了病人在报告的最大国际队列中，与直接喉镜相比，视频喉镜用于气管插管相关的集中不良结局孩子们至今。本研究的数据可用于设计充分把握度的前瞻性研究，比较气管插管期间视频喉镜与直接喉镜的患者中心结局。
Objective: Video (indirect) laryngoscopy is used as a primary tracheal intubation device for difficult airways in emergency departments and in adult ICUs. The use and outcomes of video laryngoscopy compared with direct laryngoscopy has not been quantified in PICUs or cardiac ICUs.Design: Retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from July 2010 to June 2015.Setting: Thirty-six PICUs/cardiac ICUs across the United States, Canada, Japan, New Zealand, and Singapore.Patients: Any patient admitted to a PICU or a pediatric cardiac ICU and undergoing tracheal intubation.Interventions: Use of direct laryngoscopy versus video laryngoscopy for tracheal intubation.Measurements and Main Results: There were 8,875 tracheal intubations reported in the National Emergency Airway Registry for Children database, including 7,947 (89.5%) tracheal intubations performed using direct laryngoscopy and 928 (10.5%) tracheal intubations performed using video laryngoscopy. Wide variability in video laryngoscopy use exists across PICUs (median, 2.6%; range, 0-55%). Video laryngoscopy was more often used in older children (p < 0.001), in children with history of a difficult airway (p = 0.01), in children intubated for ventilatory failure (p < 0.001), and to facilitate the completion of an elective procedure (p = 0.048). After adjusting for patient-level covariates, a secular trend, and site-level variance, the use of video laryngoscopy significantly increased over a 5-year period compared with fiscal year 2011 (odds ratio, 6.7; 95% CI, 1.7-26.8 for fiscal year 2014 and odds ratio, 11.2; 95% CI, 3.2-38.9 for fiscal year 2015). The use of video laryngoscopy was independently associated with a lower occurrence of tracheal intubation adverse events (adjusted odds ratio, 0.57; 95% CI, 0.42-0.77; p < 0.001) but not with a lower occurrence of severe tracheal intubation adverse events (adjusted odds ratio, 0.86; 95% CI, 0.56-1.32; p = 0.49) or fewer multiple attempts at endotracheal intubation (adjusted odds ratio, 0.93; 95% CI, 0.71-1.22; p = 0.59).Conclusions: Using National Emergency Airway Registry for Children data, we described patient-centered adverse outcomes associated with video laryngoscopy compared with direct laryngoscopy for tracheal intubation in the largest reported international cohort of children to date. Data from this study may be used to design sufficiently powered prospective studies comparing patient-centered outcomes for video laryngoscopy versus direct laryngoscopy during endotracheal intubation.