Prehospital standardization of medical airway management: Incidence and risk factors of difficult airway
Prehospital standardization of medical airway management: Incidence and risk factors of difficult airway
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DOI：
10.1197/j.aem.2006.02.016
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发表时间：
2006-08-01
影响因子：
4.4
通讯作者：
Dhonneur, Gilles
中科院分区：
文献类型：
--
作者：
Combes, Xavier;Jabre, Patricia;Dhonneur, Gilles
目的：院前急救医学中的困难插管发生率在已发表的研究中差异很大，并且取决于多种因素。作者的目的是确定应用镇静和插管标准方案时困难插管的发生率，并确定与院前困难气道相关的因素。 方法：这项为期 30 个月的临床、观察性、前瞻性研究是由院前急救医疗单位在法国巴黎郊区（马恩河谷，人口 1,300,000）进行的。需要气管插管的患者的气道管理已标准化。药理学程序建议对有自发性心脏活动的患者进行快速顺序插管。在喉镜辅助插管困难的情况下，提出了一种预定义的算法。计算所有需要气管插管的患者的插管难度评分（IDS），并通过多变量统计分析确定与插管困难相关的因素（IDS > 5）。 结果：在研究期间，纳入了 1,442 名患者； 640 人（44%）出现心肺骤停，802 人出现自发性心脏活动。 1% 的病例出现了偏离药理学和气道管理程序的情况。当遵循预定义的困难气道管理算法时，出现两次插管失败（0.1%）。 106 名患者 (7.4%) 的 IDS > 5，60 名患者 (4.1%) 需要首先 (n = 56) 和第二 (n = 4) 种替代技术进行气管插管。半刚性导管允许 93% 的困难插管患者进入气管。一名患者需要院前进行环甲膜切开术。与插管困难相关的因素如下：耳鼻喉肿瘤或手术史；肥胖;面部外伤；经营者的状况；结论：如果院前医疗气道管理规范并由经过培训的操作员进行，插管失败的情况很少见（0. 1%），气管插管困难的发生率为 7.4%，与心肺状态无关。
Objectives: The rate of difficult intubation in prehospital emergency medicine varies greatly among studies already published and depends on several factors. The authors' objective was to determine the rate of difficult intubations and to determine factors associated with prehospital difficult airways when a standard protocol for sedation and intubation was applied.Methods: This 30-month clinical, observational, prospective study was performed in a suburb of Paris, France (Val de Marne, population 1,300,000) by a prehospital emergency medical unit. Airway management for patients who needed tracheal intubation was standardized. The pharmacological procedure recommended rapid sequence intubation for patients with spontaneous cardiac activity. In cases of difficult, laryngoscopy-assisted intubation, a predefined algorithm was proposed. The Intubation Difficulty Score (IDS) was calculated for all patients requiring tracheal intubation, and factors associated with difficult intubation, defined by IDS of > 5, were identified by using multivariate statistical analysis.Results: During the study period, 1,442 patients were included; 640 (44%) were in cardiorespiratory arrest, and 802 had a spontaneous cardiac activity. Deviation from the pharmacological and airway management procedures occurred in 1% of cases. When the predefined difficult airway management algorithm was followed, failure to intubate was encountered twice (0.1%). One hundred six (7.4%) patients had an IDS of > 5, and 60 (4.1%) required first (n = 56) then second (n = 4) alternative techniques for tracheal intubation. Semirigid leaders allowed tracheal access in 93% of difficult-intubation patients. One patient required a prehospital cricothyroiclotomy. Factors associated with difficult intubation were the following: a history of ear, nose, or throat neoplasia or surgery; obesity; facial trauma; the operator's status; and the operator's position.Conclusions: If prehospital medical airway management is standardized and performed by trained operators, failure to intubate is rare (0. 1%), and the incidence of difficult tracheal intubation is 7.4%, independent of cardiorespiratory status.