Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment.
Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment.
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DOI：
10.1186/s40779-017-0129-2
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发表时间：
2017
影响因子：
21.1
通讯作者：
Lisco SJ
中科院分区：
文献类型：
--
作者：
Wallace MC;Britton ST;Meek R;Walsh-Hart S;Carter CTE;Lisco SJ
正在进行军事医疗后送的危重或受伤患者可能需要紧急插管。插管可能会挽救生命，但也有风险。新手或不频繁的喉镜医生有一个明显的劣势，因为经验对于快速和安全地建立安全的呼吸道至关重要。这一挑战因停电条件下飞机后部的严酷环境而变得更加复杂。这项研究确定了五种不同的视频辅助插管设备(VAID)中哪一种最适合美国空军重症监护空运团队在飞行中使用，方法是比较新手和专业喉镜医生在三种情况下成功插管的时间：正常气道照明(NAL)、困难气道照明(DAL)和困难呼吸道阻断(DAB)，在标准军用运输支架和地板上使用人体模型，设置时间和外部光发射最少。一个方便的样本大小的40名参与者(24名新手和16名专家)试图在高保真的呼吸道假人上使用5种不同的视频喉镜设备进行插管。记录气管插管时间和最优化操作次数。Kruskal-Wallis测试确定了VAID在每种特定情况下插管的时间上的显著差异。有显著差异的设备使用秩和分析进行配对比较测试，以进一步澄清差异。记录设备组装时间、启动时间和发出的光量。对感知的易用性进行了调查。在所有困难的呼吸道场景中，初学者使用宾得AWS的速度最快。专家记录了5个设备中一致使用3个设备的最短中值时间。在测试的6个场景中，AWS在4个场景中整体表现优异。专家和新手主观上认为GlideScope Ranger最容易使用。所有设备发出的光都少于美国空军发布的前照灯。在所有困难的呼吸道情况下，新手使用宾得AWS插管最快。GlideScope需要的设置时间最短，参与者认为这款设备最容易使用。GlideScope和AWS的总设置时间是最快的两个。这两种设备都适合不经常使用和经验丰富的喉镜医生在飞行中使用。
The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks. The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices (VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on (NAL), Difficult Airway Lights on (DAL) and Difficult Airway Blackout (DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission. A convenience sample size of 40 participants (24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the GlideScope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp. Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The GlideScope required the shortest setup time, and participants judged this device as the easiest to use. The GlideScope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists.