小柯机器人

美国范德比尔特大学医学中心Jonathan D. Casey团队比较了危重患者首次尝试气管插管时使用探条与带导管芯的气管插管的成功插管率。相关论文于2021年12月8日发表在《美国医学会杂志》上。

对于接受紧急气管插管的危重患者来说，首次尝试插管失败率高达20%，且与严重低氧血症和心脏骤停相关。与使用带导管芯的气管插管相比，使用气管导管插管器（“探条”）是否会增加插管成功的可能性仍不确定。

为了探讨带探条与带导管芯气管插管对首次插管成功率的影响，2019年4月29日至2021年2月14日，研究组在美国7个急诊科和8个重症监护病房进行了一项多中心、随机、临床试验，共招募了1102名接受气管插管的危重成人患者，最后随访日期为2021年3月14日。

研究组将参与者随机分配，其中556名使用探条气管插管，546名使用带导管芯的气管插管。主要结局是首次插管成功，次要结局是严重低氧血症的发生率，定义为外周血氧饱和度低于80%。

在1106名随机分组的患者中，共有1102名（99.6%）完成了试验并被纳入初步分析（中位年龄58岁；41.0%为女性）。探条组中有447名患者（80.4%）首次插管成功，导管芯组中有453名患者（83.0%），组间差异不显著。

探条组共有58名患者（11.0%）出现严重低氧血症，导管芯组有46名（8.8%）。探条组有4名患者（0.7%）发生食管插管，导管芯组有5名（0.9%）；探条组有14名患者（2.5%）插管后出现气胸，导管芯组有15名（2.7%）；探条组没有患者出现口腔、声门或胸部结构损伤，导管芯组有3名（0.5%）。

研究结果表明，对于接受气管插管的危重成人患者，与使用带导管芯的气管插管相比，使用探条并未显著增加首次插管成功率。

附：英文原文

Title: Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial

Author: Brian E. Driver, Matthew W. Semler, Wesley H. Self, Adit A. Ginde, Stacy A. Trent, Sheetal Gandotra, Lane M. Smith, David B. Page, Derek J. Vonderhaar, Jason R. West, Aaron M. Joffe, Steven H. Mitchell, Kevin C. Doerschug, Christopher G. Hughes, Kevin High, Janna S. Landsperger, Karen E. Jackson, Michelle P. Howell, Sarah W. Robison, John P. Gaillard, Micah R. Whitson, Christopher M. Barnes, Andrew J. Latimer, Vikas S. Koppurapu, Bret D. Alvis, Derek W. Russell, Kevin W. Gibbs, Li Wang, Christopher J. Lindsell, David R. Janz, Todd W. Rice, Matthew E. Prekker, Jonathan D. Casey, BOUGIE Investigators and the Pragmatic Critical Care Research Group, Christopher S Gray, Andrea Fletcher, Sally Dye, Swati Gulati, Michael C Kurz, Carolynn Lyle, Stephanie Gravitz, Erika LW Rice, Nathaniel D Westphal, Itay Bentov, Jamie Stang, Paige DeVries, Ellen Maruggi, Bradley Lloyd, Anthony T Defebio, Feysel Mohamed, Robert Mitchell, Justin N Oeth, Angela Otoo, Elizabeth A Farmer, Dvonne A Duran, Cori Withers, Jennifer Friedel, Karina M Nava, Anna Altz-Stamm, Cristina Bardita, Mary C Boone, Joe W Chiles, Kristina Collins, Abby Drescher, Kevin G Dsouza, Janna Dunn, Stacy Ejem, Josh Gautney, Nicole Harris, Savannah Herder, Tamer Hudali, R. Chad Wade

Issue&Volume: 2021-12-08

Abstract:

Importance  For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer (“bougie”) increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain.

Objective  To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.

Design, Setting, and Participants  The Bougie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial was a multicenter, randomized clinical trial among 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the US between April 29, 2019, and February 14, 2021; the date of final follow-up was March 14, 2021.

Interventions  Patients were randomly assigned to use of a bougie (n=556) or use of an endotracheal tube with stylet (n=546).

Main Outcomes and Measures  The primary outcome was successful intubation on the first attempt. The secondary outcome was the incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%.

Results  Among 1106 patients randomized, 1102 (99.6%) completed the trial and were included in the primary analysis (median age, 58 years; 41.0% women). Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (absolute risk difference, 2.6 percentage points [95% CI, 7.3 to 2.2]; P=.27). A total of 58 patients (11.0%) in the bougie group experienced severe hypoxemia, compared with 46 patients (8.8%) in the stylet group (absolute risk difference, 2.2 percentage points [95% CI, 1.6 to 6.0]). Esophageal intubation occurred in 4 patients (0.7%) in the bougie group and 5 patients (0.9%) in the stylet group, pneumothorax was present after intubation in 14 patients (2.5%) in the bougie group and 15 patients (2.7%) in the stylet group, and injury to oral, glottic, or thoracic structures occurred in 0 patients in the bougie group and 3 patients (0.5%) in the stylet group.

Conclusions and Relevance  Among critically ill adults undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with use of an endotracheal tube with stylet.

DOI: 10.1001/jama.2021.22002

Source: https://jamanetwork.com/journals/jama/fullarticle/2787158

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