{"title":"视频喉镜检查可改善重症患者的插管效果：随机对照试验的系统回顾和荟萃分析。","authors":"Kai Zhang, Chao Zhong, Yuhang Lou, Yushi Fan, Ningxin Zhen, Tiancha Huang, Chengyang Chen, Hui Shan, Linlin Du, Yesong Wang, Wei Cui, Lanxin Cao, Baoping Tian, Gensheng Zhang","doi":"10.1136/emermed-2023-213860","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical outcomes of emergency tracheal intubation.</p><p><strong>Methods: </strong>We searched the PubMed, Embase, Scopus and Cochrane databases up to 5 September 2024. Randomised controlled trials comparing video laryngoscopy with direct laryngoscopy for emergency tracheal intubation were analysed. The primary outcome was the first-attempt success rate, while secondary outcomes included intubation time, glottic visualisation, in-hospital mortality and complications.</p><p><strong>Results: </strong>Twenty-six studies (6 in prehospital settings and 20 in hospital settings) involving 5952 patients were analysed in this study. Fifteen studies had low risk of bias. Overall, there was no significant difference in first-attempt success rate between two groups (RR 1.05, 95% CI 0.97 to 1.13, p=0.24, I<sup>2</sup>=89%). However, video laryngoscopy was associated with a higher first-attempt success rate in hospital settings (emergency department: RR 1.13, 95% CI 1.03 to 1.23, p=0.007, I<sup>2</sup>=85%; intensive care unit: RR 1.16, 95% CI 1.05 to 1.29, p=0.003, I<sup>2</sup>=68%) and among inexperienced operators (RR 1.15, 95% CI 1.03 to 1.28, p=0.01, I<sup>2</sup>=72%). Conversely, the first-attempt success rate with video laryngoscopy was lower in prehospital settings (RR 0.75, 95% CI 0.57 to 0.99, p=0.04, I<sup>2</sup>=95%). There were no differences for other outcomes except for better glottic visualisation (RR 1.11, 95% CI 1.03 to 1.20, p=0.005, I<sup>2</sup>=91%) and a lower incidence of oesophageal intubation (RR 0.42, 95% CI 0.24 to 0.71, p=0.001, I<sup>2</sup>=0%) when using video laryngoscopy.</p><p><strong>Conclusions: </strong>In hospital settings, video laryngoscopy improved first-attempt success rate of emergency intubation, provided superior glottic visualisation and reduced incidence of oesophageal intubation in critically ill patients. 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引用次数: 0
摘要
背景：视频喉镜检查在需要紧急气管插管的重症患者中的作用仍存在争议。本系统综述和荟萃分析旨在评估视频喉镜是否能改善紧急气管插管的临床效果：我们检索了截至 2024 年 9 月 5 日的 PubMed、Embase、Scopus 和 Cochrane 数据库。分析了视频喉镜与直接喉镜在紧急气管插管中的对比随机对照试验。主要结果是首次尝试成功率，次要结果包括插管时间、声门视野、院内死亡率和并发症：本研究分析了 26 项研究（6 项在院前环境中进行，20 项在医院环境中进行），涉及 5952 名患者。其中 15 项研究的偏倚风险较低。总体而言，两组首次尝试成功率无明显差异（RR 1.05，95% CI 0.97 至 1.13，P=0.24，I2=89%）。然而，在医院环境中，视频喉镜检查的首次尝试成功率更高（急诊科：RR 1.13，95% CI 0.97 至 1.13，I2=89%）：RR 1.13，95% CI 1.03 至 1.23，P=0.007，I2=85%；重症监护室：RR 1.16，95% CI 1.05 至 1.29，P=0.003，I2=68%）和缺乏经验的操作者（RR 1.15，95% CI 1.03 至 1.28，P=0.01，I2=72%）。相反，院前环境中首次尝试视频喉镜检查的成功率较低（RR 0.75，95% CI 0.57 至 0.99，P=0.04，I2=95%）。使用视频喉镜时，除了声门视野更好（RR 1.11，95% CI 1.03 至 1.20，p=0.005，I2=91%）和食道插管发生率较低（RR 0.42，95% CI 0.24 至 0.71，p=0.001，I2=0%）外，其他结果没有差异：结论：在医院环境中，视频喉镜提高了急诊插管的首次尝试成功率，提供了更好的声门视野，降低了重症患者食道插管的发生率。我们的研究结果支持在急诊科和重症监护室常规使用视频喉镜：Prospero 注册号：CRD 42023461887。
Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials.
Background: The role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical outcomes of emergency tracheal intubation.
Methods: We searched the PubMed, Embase, Scopus and Cochrane databases up to 5 September 2024. Randomised controlled trials comparing video laryngoscopy with direct laryngoscopy for emergency tracheal intubation were analysed. The primary outcome was the first-attempt success rate, while secondary outcomes included intubation time, glottic visualisation, in-hospital mortality and complications.
Results: Twenty-six studies (6 in prehospital settings and 20 in hospital settings) involving 5952 patients were analysed in this study. Fifteen studies had low risk of bias. Overall, there was no significant difference in first-attempt success rate between two groups (RR 1.05, 95% CI 0.97 to 1.13, p=0.24, I2=89%). However, video laryngoscopy was associated with a higher first-attempt success rate in hospital settings (emergency department: RR 1.13, 95% CI 1.03 to 1.23, p=0.007, I2=85%; intensive care unit: RR 1.16, 95% CI 1.05 to 1.29, p=0.003, I2=68%) and among inexperienced operators (RR 1.15, 95% CI 1.03 to 1.28, p=0.01, I2=72%). Conversely, the first-attempt success rate with video laryngoscopy was lower in prehospital settings (RR 0.75, 95% CI 0.57 to 0.99, p=0.04, I2=95%). There were no differences for other outcomes except for better glottic visualisation (RR 1.11, 95% CI 1.03 to 1.20, p=0.005, I2=91%) and a lower incidence of oesophageal intubation (RR 0.42, 95% CI 0.24 to 0.71, p=0.001, I2=0%) when using video laryngoscopy.
Conclusions: In hospital settings, video laryngoscopy improved first-attempt success rate of emergency intubation, provided superior glottic visualisation and reduced incidence of oesophageal intubation in critically ill patients. Our findings support the routine use of video laryngoscopy in the emergency department and intensive care units.
期刊介绍：
The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.
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