Background

The risk of severe medical and surgical events during long-duration spaceflight is significant. In space, many environmental and psychological factors may make tracheal intubation more difficult than on Earth. We hypothesised that, in microgravity, tracheal intubation may be facilitated by the use of a videolaryngoscope compared with direct laryngoscopy.

Methods

In a non-randomised, controlled, cross-over simulation study, we compared intubation performance of novice operators and experts, using either a direct laryngoscope or a videolaryngoscope, in weightlessness and in normogravity. The primary outcome was the success rate of tracheal intubation. Time to intubation and the confidence score into the success of tube placement were also recorded.

Results

When novices attempted to intubate the trachea in microgravity, the success rate of tracheal intubation using a videolaryngoscope was significantly higher (20/25 [80%]; 95% confidence interval [CI], 64.3–95.7 vs eight/20 [40%]; 95% CI, 18.5–61.5; P=0.006), and intubation time was shorter, compared with using a direct laryngoscope. In normogravity, the success rate of tracheal intubation by experts was significantly higher than that by novices (16/20 [80%]; 95% CI, 62.5–97.5 vs seven/25 [28%]; 95% CI, 10.4–45.6; P=0.001), but in microgravity, there was no significant difference between the experts and novices (19/20 [95%]; 95% CI, 85.4–100 vs 20/25 [80%]; 95% CI, 64.3–95.7; P=0.113). Higher confidence scores were achieved with videolaryngoscopy compared with direct laryngoscopy by both experts and novices in both microgravity and normogravity.

Conclusions

Videolaryngoscopy was associated with higher intubation success rate and speed, and higher confidence for correct tube placement by novice operators in microgravity, and as such may represent the best technique for advanced airway management during long-duration spaceflight.

中文翻译：

---

微重力气管插管：比较直接喉镜和视频喉镜†的模拟研究。

背景

在长时间的太空飞行中，发生严重医疗和手术事件的风险很大。在太空中，许多环境和心理因素可能会使气管插管比在地球上困难。我们假设，在微重力下，与直接喉镜相比，使用视频喉镜可以促进气管插管。

方法

在一项非随机，对照，交叉模拟研究中，我们比较了使用直接喉镜或视频喉镜的初学者和专家在失重和正常重力下的插管性能。主要结果是气管插管成功率。还记录了插管时间和成功置管的置信度得分。

结果

当新手尝试在微重力下气管插管时，使用视频喉镜进行气管插管的成功率显着更高（20/25 [80％]； 95％置信区间[CI]为64.3–95.7，而八分之20 [40％]） ； 95％CI，18.5–61.5；P = 0.006），与使用直接喉镜相比，插管时间更短。在正常重力下，专家们的气管插管成功率显着高于新手（16/20 [80％]； 95％CI，62.5–97.5 vs 7/25 [28％]； 95％CI，10.4–45.6 ; P = 0.001），但在微重力下，专家和新手之间没有显着差异（19/20 [95％]； 95％CI，85.4–100与20/25 [80％]； 95％CI，64.3 –95.7; P= 0.113）。专家和新手在微重力和正重力方面，使用视频喉镜检查均比直接喉镜检查有更高的置信度得分。

结论

喉镜检查与较高的插管成功率和速度以及新手操作员在微重力下正确放置导管的置信度更高相关，因此可能代表长期航天过程中进行先进气道管理的最佳技术。