Use of stylet and airway management procedure in critically ill patients
Use of stylet and airway management procedure in critically ill patients
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在危重患者中使用管心针和气道管理程序
DOI：
10.1007/s00134-021-06476-1
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发表时间：
2021
影响因子：
38.9
通讯作者：
Nagashima Michio
中科院分区：
文献类型：
--
作者：
Masuda Takahiro;Nosaka Nobuyuki;Uchimido Ryo;Nagashima Michio
我们怀着极大的兴趣阅读了Jaber等人最近发表在《重症监护医学》上的研究[1]，其中作者研究了在气管插管过程中常规使用管口对首次插管成功的影响。在他们的多中心随机对照试验中，使用管口插管导致首次插管成功率显著高于单独使用气管插管(78.2%比71.5%，相对风险1.10)。为防止插管失败而需要使用注射器治疗的人数为14.8人。值得注意的是，这是第一次定量评估插管中使用管口的效果的研究，结果非常有启发性和教育性，我们同意应该向所有临床医生推荐气管插管中的管口。与最近一项关于插管实践的国际前瞻性观察研究(INTUBE研究)的数据比较[2]可能会增加一个有益的讨论。在STYLETO的研究中，值得注意的是，无论使用针头，数量都更少(几乎一半！)与INTUBE研究报告的(45.2%)相比，观察到的严重并发症(25.6%)。STYLETO研究中使用的插管程序标准化(蒙彼利埃插管方案)可能有力地预防插管期间并发症的发生[3]。值得注意的是，STYLETO研究和INTUBE研究对诱导剂的选择完全不同：氯胺酮分别为68.9%和14.2%；异丙酚分别为13.2%和41.5%。尽管危重病人使用氯胺酮插管有利弊[4]，但由于其更有益的血流动力学效应，氯胺酮一直被认为是首选的诱导剂[5]。在STYLETO试验中，这些因素加在一起可能导致插管期间并发症的发生率较低。为了使危重患者获得更安全的气管插管，最佳诱导剂的选择仍然是有保证的。同时，我们要赞扬作者进行了这样一项重要的研究，首次定量报道了插管针的效果。进一步的临床研究，预示插管和并发症之间的关系，可能会补充Jaber等人的大量数据。
We have read with great interest the study by Jaber et al.[1] recently published in Intensive Care Medicine, where the authors studied the effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success. In their multi-center randomized controlled trial, the use of a stylet for tracheal intubation resulted in significantly higher first-attempt intubation success than the use of tracheal tube alone (78.2% vs. 71.5%, relative risk 1.10). The number needed to treat with a stylet to prevent on intubation failure was 14.8. Notably, this is the first study to evaluate quantitatively the effect of using a stylet in intubation, and the result is very informative and educational, and we agree that a stylet should be recommended for all clinicians in tracheal intubation. Data comparison with a recent international prospective observational study for intubation practices (INTUBE study)[2] may add an informative discussion. Of note in the STYLETO study is the fact that, regardless of the use of a stylet, there are less (almost a half!) severe complications observed (25.6%) when compared to those reported in the INTUBE study (45.2%). Standardization of the intubation procedure used in the STYLETO study (Montpellier intubation protocol) might strongly prevent the incidence of complications during intubation [3]. It is also interesting to note that the choice of induction agent differs entirely between the STYLETO study and the INTUBE study: ketamine, 68.9% vs 14.2%; propofol, 13.2% vs 41.5%, respectively. Although there are pros and cons over the use of ketamine for intubation of critically ill patients [4], ketamine has been advocated as the induction agent of choice, given its more beneficial hemodynamic effect [5]. These factors taken together might result in the lower incidence of complications during intubation in the STYLETO trial. Elucidation of the best choice of induction agent is still warranted to achieve safer tracheal intubation for the critically ill patients.Again, we would applaud the authors for performing such an important study, which reported the effect of a stylet for intubation quantitatively for the first time. Further clinical studies, auguring the relationship between the intubation and the complications, may complement the great data by Jaber et al.
影响因子：
38.9
作者：
Jaber S;Rollé A;Godet T;Terzi N;Riu B;Asfar P;Bourenne J;Ramin S;Lemiale V;Quenot JP;Guitton C;Prudhomme E;Quemeneur C;Blondonnet R;Biais M;Muller L;Ouattara A;Ferrandiere M;Saint-Léger P;Rimmelé T;Pottecher J;Chanques G;Belafia F;Chauveton C;Huguet H;Asehnoune K;Futier E;Azoulay E;Molinari N;De Jong A;STYLETO trial group
通讯作者：
STYLETO trial group
作者回应：“氯胺酮作为困难气道的单一疗法尚未准备好迎接黄金时期”
影响因子：
3.1
作者：
Andrew Merelman;Michael C. Perlmutter;R. Strayer
通讯作者：
R. Strayer
氯胺酮作为困难气道单一疗法尚未准备好迎接黄金时期
影响因子：
3.1
作者：
B. Driver;R. Reardon;J. Mosier
通讯作者：
J. Mosier