Channelled versus nonchannelled Macintosh videolaryngoscope blades in patients with a cervical collar: a randomized controlled noninferiority trial.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2024-09-01 Epub Date: 2024-05-22 DOI:10.1007/s12630-024-02769-3

Kyung Won Shin, Sang Phil Lee, Taeyup Kim, Seungeun Choi, Yoon Jung Kim, Hee-Pyoung Park, Hyongmin Oh

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引用次数: 0

Abstract

Purpose: Channelled blades have the advantage of avoiding stylet use and potential airway injury during videolaryngoscopic intubation. Nevertheless, the effectiveness of channelled Macintosh-type blades has not yet been fully established. We sought to assess the utility of channelled Macintosh-type blades for videolaryngoscopic intubation under cervical spine immobilization.

Methods: We conducted a randomized controlled noninferiority trial in neurosurgical patients with a difficult airway simulated by a cervical collar. Videolaryngoscopic intubation with a reinforced tracheal tube was performed using a channelled Macintosh-type blade without a stylet (channelled group, n = 130) or a nonchannelled Macintosh-type blade with a stylet (nonchannelled group, n = 131). The primary outcome was intubation success rate. Secondary outcomes included time to intubation and incidence or severity of intubation-related complications (subglottic, lingual, and dental injuries; bleeding; sore throat; and hoarseness).

Results: The initial intubation success rate was 98% and 99% in the channelled and nonchannelled groups, respectively, showing the noninferiority of the channelled group (difference in proportions -0.8%; 95% confidence interval [CI], -4.8% to 2.9%; predefined noninferiority margin, -5%; P = 0.62). Fewer participants in the channelled group had subglottic injuries than in the nonchannelled group (32% [32/100] vs 57% [54/95]; difference in proportions, -25%; 95% CI, -39% to -11%; P < 0.001). There were no significant differences between the two groups in the overall intubation success rate, time to intubation, and incidence or severity of other intubation-related complications.

Conclusions: For videolaryngoscopic intubation in patients with a cervical collar, channelled Macintosh-type blades are an alternative to nonchannelled Macintosh-type blades, with a noninferior initial intubation success rate and a lower incidence of subglottic injury.

Study registration: CRIS.nih.go.kr ( KCT0005186 ); first submitted 29 June 2020.

Abstract Image

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在佩戴颈圈的患者中使用有通道与无通道 Macintosh 视频喉镜刀片：随机对照非劣效性试验。

目的：导管刀片的优点是在视频喉镜插管过程中避免使用支架和潜在的气道损伤。然而，Macintosh 型导流刀片的有效性尚未完全确定。我们试图评估在颈椎固定的情况下视频咽喉镜插管时使用导流式 Macintosh 型刀片的效用：我们在神经外科患者中进行了一项随机对照非劣效性试验，患者使用颈椎项圈模拟困难气道。使用不带支架的Macintosh型通道式刀片（通道式组，n = 130）或带支架的Macintosh型非通道式刀片（非通道式组，n = 131），用加强型气管导管进行视频喉镜插管。主要结果是插管成功率。次要结果包括插管时间和插管相关并发症的发生率或严重程度（声门下、舌部和牙齿损伤；出血；咽喉痛；声音嘶哑）：导管组和非导管组的初始插管成功率分别为 98% 和 99%，显示出导管组的非劣效性（比例差异 -0.8%；95% 置信区间 [CI]，-4.8% 至 2.9%；预定义非劣效差值，-5%；P = 0.62）。与非通道组相比，通道组出现声门下损伤的人数更少（32% [32/100] vs 57% [54/95]；比例差异，-25%；95% 置信区间 [CI]，-39% 至 -11%；P 结论：视频喉镜插管术与非通道组相比，其效果更佳：对于有颈椎项圈的患者进行视频喉镜插管，带导管的Macintosh型刀片是非带导管Macintosh型刀片的替代品，其初始插管成功率和声门下损伤发生率均低于非带导管Macintosh型刀片：研究注册：CRIS.nih.go.kr ( KCT0005186 ); 2020年6月29日首次提交。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.