Modelling the difficult airway —how real is faking it?
Modelling the difficult airway —how real is faking it?
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模拟困难气道——假装它有多真实？
DOI：
10.1007/bf03017918
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
E. Crosby
中科院分区：
文献类型：
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作者：
E. Crosby
它和直接喉镜一样有效吗？如果不能对这两个问题做出肯定的回答，该设备似乎就会被扔进垃圾堆。需要注意的是，也是重要的一点是，确保评估者已完成必要的基础工作（至少阅读产品说明书），并在宣布该工具不可行之前了解该工具的用途。一些非常有用的设备（例如，柔性和刚性光纤内窥镜）具有更平坦的学习曲线 - 重要的是要确保类似的具有挑战性的设备不会因为评估者尚未获得技术便利而过早地被认为没有用处而被忽视。很难批判性地评估一些可能对特定设备得出负面结论的报告，因为与评估者相关的详细信息要么未包含在文本中，要么提供的信息表明评估者可能对设备的经验有限。 10, 11 在评估新技术和工具在困难气道管理中应用的有效性的已发表研究中，针对实际患有困难气道的患者的最佳和最有用的报告。 12, 13 这些论文与临床医生极为相关，因为它们提供了有关现实世界中经验丰富的用户可能期望和实现的目标的信息。此外，如果研究涉及足够多的受试者，他们可能会确定该技术可能特别有用或可能不特别有用的亚群。 13 不幸的是，这些研究进行起来既乏味又耗时，因为招募大量患有罕见疾病的患者很困难。另一种策略是模拟正常患者的困难气道，然后在具有挑战性的错觉下评估工具和技术。我们已经确定了导致喉镜检查和/或气管插管困难的患者特征（和环境因素）。例如，我们知道颈部运动受限和张口受限 (Mallampati 3/4) 的结合是喉镜检查困难的有力预测因素。在患者身上放置硬质颈托可以限制颈部弯曲、头部伸展和张口，并创建一个复制上述组合的模型。该模型近似于困难气道的一种形式——前喉。 11, 14 “真正的”3 级喉镜检查在此模拟中非常常见，它很可能可用于准确评估困难喉镜检查所提倡的工具和技术。如果传递了有关评估人员对被评估设备的经验水平的信息，则有关使用此模型评估的工具和技术的实用性的结论可能是相关的。
I does it work as well as the direct laryngoscope? A failure to answer both questions in the affirmative would seemingly relegate the device to the trash-heap. A caveat, and an important one, would be to ensure that the evaluator has done the necessary groundwork (reading the product insert at a minimum) and has a sense of how it is intended that the instrument be used before declaring it to be non-viable. Some very useful devices (eg, flexible and rigid fibreoptic endoscopes) have flatter learning curves-it is important to ensure that similar challenging devices are not prematurely dismissed as having no utility when the truth might be that the evaluator has not yet achieved technical facility with it. It is difficult to critically evaluate some reports which may conclude negatively about particular devices because detailed information related to the evaluators is either not included in the text or if the information provided suggests that the evaluators may have had limited experience with the devices. 10, 11 Of the studies published assessing the effectiveness of new techniques and tools applied in the management of difficult airways, the best and most useful report on patients who actually possess a difficult airway. 12, 13 These papers are extremely relevant to clinicians as they provide information as to what might be expected and achieved by experienced users in the real world. Additionally, if the studies involve enough subjects, they may identify sub-populations for whom the technique might be or might not be particularly usefull. 13 Unfortunately, these studies are tedious and time-consuming to carry out because of the difficulty involved in recruiting large numbers of patients with uncommon conditions.An alternate strategy is to simulate a difficult airway in normal patients and then to evaluate tools and techniques under a challenging illusion. We have identified patient characteristics (and environmental factors) which predispose to difficult laryngoscopy and/or tracheal intubation. For example, we know that the combination of limited neck movement and limited mouth opening (Mallampati 3/4) is a powerful predictor of difficult laryngoscopy. Placing a hard cervical collar on a patient limits neck flexion, head extension and mouth opening and creates a model replicating the above combinationthis model approximates a form of a difficult airway-the anterior larynx. 11, 14 A “true” Grade 3 laryngoscopy is very common in this simulation and it is likely that it can be used to accurately assess tools and techniques advocated for difficult laryngoscopy. Conclusions regarding the utility of the tools and techniques assessed with this model are likely to be relevant provided information is relayed as to the experience level of the evaluators with the equipment being assessed.