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Nationwide survey on training and device utilization during tracheal intubation in French intensive care units.
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2020-01-03 , DOI: 10.1186/s13613-019-0621-9
M Martin 1 , P Decamps 1 , A Seguin 1 , C Garret 1 , L Crosby 1 , O Zambon 1 , A F Miailhe 1 , E Canet 1 , J Reignier 1 , J B Lascarrou 1 ,
Affiliation  

BACKGROUND Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20-40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs. MATERIALS AND METHODS We conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU. RESULTS Of 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq® was the most often used videolaryngoscope (39.3%), followed by McGrath®Mac (36.9%) then by Glidescope® (14.5%). CONCLUSION Nearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.

中文翻译:

法国重症监护病房气管插管期间培训和设备使用情况的全国性调查。

背景技术插管是一种挽救生命的程序,通常在重症监护病房(ICU)患者中进行,但在20-40%的情况下会导致严重的不良事件。最近的试验旨在提供有关哪种药物,设备和方式最大程度提高患者安全性的指导。喉镜的选择范围越来越广,并被用于扩大适应症(从困难的插管到不明显的插管)。这项研究的目的是描述法国ICU中的插管实践和设备可用性。材料和方法我们通过电子邮件将匿名的26项调查问卷发送给法国ICU的医生,进行了一项全国性在线调查。将一张问卷发送给每个ICU的主管或插管专家。结果在257个ICU中,有180个(70%)返回了完整的问卷。结果显示,有43%的插管者不完全熟练插管;其中,18.8%的人没有接受插管训练或仅接受了基础训练(在床边的讲座和观察)。在参与检查的ICU中,有94.4%的患者有困难的插管手推车,插管方案为74.5%,二氧化碳描记仪为92.2%(通常用于检查装有该设备的ICU中有69.3%的患者为试管),91.6%的喉罩,正面为97.2%颈部访问功能,以及视频喉镜的76.6%。在插管困难的情况下,有85.6%的ICU使用bougie(154/180),而有7.8%的患者使用了视频喉镜(14/180)。对于84%的ICU(154/180)中的困难插管,保留了使用视频喉镜的权利。使用电子喉镜与使用插管协议(P = 0.043)和使用二氧化碳图(P = 0.02)显着相关。Airtraq®是最常用的视频喉镜(39.3%),其次是McGrath®Mac(36.9%),其次是Glidescope®(14.5%)。结论在法国重症监护病房中,将近一半的插管者不能完全熟练使用OTI。无法获得诸如模拟之类的现代培训方法。大多数ICU拥有一个视频喉镜,但将其保留用于困难的插管。
更新日期:2020-01-04
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