手术室与重症监护室气管插管条件的比较：前瞻性观察研究
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Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit
背景与目的
气管插管是手术室和重症监护室的常见干预措施。作者假设，与手术室相比，使用直接喉镜进行气管插管会导致插管条件恶化，重症监护室出现更多并发症。
方 法
作者在33个月内对手术室喉镜下直接气管插管，随后在重症监护病房进行了前瞻性评估（在1个月的时间范围内）。主要结果是比较在重症监护病房和手术室中进行气管插管的同一患者采用改良Cormack-Lehane等级声门可视程度的差异。次要结果是比较第一次成功率、技术难度（尝试次数、操作员报告的难度、辅助需求）和并发症的发生率。
结 果
共有208名患者符合纳入标准。与手术室相比，重症监护病房的气管插管与声门可视化更差（Cormack-Lehane I / IIa / IIb / III / IV级：116/24/47/19/2）（Cormack-Lehane I级/ IIa / IIb / III / IV：159/21/16/12/0; P <0.001）。与手术室（201/208; 97％; P = 0.002）相比，重症监护病房的首次插管成功率较低（185/208; 89％）。与手术室相比，重症监护室的气管插管增加了中度和困难插管的发生率（33/208 [16％] vs. 18/208 [9％]; P <0.001），以及需要辅助喉镜检查的几率（40/208）[19％] vs. 21/208 [10％]; P = 0.002）。与手术室（13/208; 6％; P <0.001）相比，重症监护室气管插管时的并发症更为常见（76/208; 37％）。
结 论
与手术室相比，在重症监护室进行气管插管有插管条件恶化和并发症增加的风险。
原始文献摘要
M Taboada ， P Doldan ， A Calvo ， X Almeida ；Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit:A Prospective, Observational Study. Anesthesiology. 2018 Aug;129(2):321-328. doi: 10.1097/ALN.0000000000002269.
Background: Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room.
Methods: The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications.
Results: A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV: 116/24/47/19/2) compared with the operating room
(Cormack-Lehane grade I/IIa/IIb/III/IV: 159/21/16/12/0; P < 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations
in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P < 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the
operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P < 0.001).
Conclusions: Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications.
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