Background

Using a Macintosh-style videolaryngoscope as a first-intention device for tracheal intubation of unselected patients in the operating room has not often been studied. We hypothesised that using a Macintosh-style videolaryngoscope as a first-intention device is associated with an increased proportion of easy tracheal intubation.

Methods

In a quality improvement project for airway management aimed at implementing a Macintosh-style videolaryngoscope as a first-intention device, we included all consecutive tracheal intubations in adults from March, 2017 to September, 2020 in two French teaching hospitals. We divided the cohort into three temporal cohorts: the pre-intervention, implementation, and post-intervention periods. The primary outcome was the proportion of easy airway management. The secondary outcomes were the rescue technique, Cormack–Lehane III or IV view, and operator-reported difficulty of intubation. Data from one hospital compliant with the quality improvement project were compared with data from a non-compliant hospital.

Results

A total of 26 692 tracheal intubations were performed. Among 11 938 intubations included in the compliant hospital, 5487 were included in the pre-intervention, 1845 in the implementation, and 4606 in the post-intervention periods. In comparison to the pre-intervention period, the proportions of easy tracheal intubation increased from 94.3% (5177 of 5487) to 98.7% (4547 of 4606)) in the post-intervention period (+4.4% [95% confidence interval 3.7–5.1%], P<0.001). In comparison to the pre-intervention period, all secondary outcome proportions were significantly lower in the post-intervention period. No significant changes were noted in the non-compliant hospital between the pre- and post-intervention periods.

Conclusions

Using a Macintosh-style videolaryngoscope as a first-intention device for tracheal intubation in the operating room was associated with a significant increase in the proportion of easy tracheal intubation, compared with use of the standard Macintosh laryngoscope.

中文翻译：

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可视喉镜作为未选择手术患者气管插管的首选技术：一项前后观察性研究

背景

使用 Macintosh 式视频喉镜作为手术室未选定患者气管插管的首选设备的研究并不多见。我们假设使用 Macintosh 风格的视频喉镜作为第一意图设备与容易气管插管的比例增加有关。

方法

在旨在实施 Macintosh 式视频喉镜作为第一意图设备的气道管理质量改进项目中，我们纳入了 2017 年 3 月至 2020 年 9 月在两家法国教学医院进行的所有成人连续气管插管。我们将队列分为三个时间队列：干预前、实施和干预后时期。主要结果是容易气道管理的比例。次要结果是救援技术、Cormack-Lehane III 或 IV 视图，以及操作者报告的插管困难。将符合质量改进项目的一家医院的数据与一家不符合要求的医院的数据进行了比较。

结果

总共进行了 26 692 次气管插管。合规医院纳入插管11 938例，干预前5 487例，实施中1 845例，干预后4 606例。与干预前相比，干预后容易气管插管的比例从 94.3%（5487 人中的 5177 人）增加到 98.7%（4606 人中的 4547 人）（+4.4% [95% 置信区间 3.7– 5.1%]，P <0.001）。与干预前相比，干预后所有次要结果的比例均显着降低。在干预前和干预后期间，不合规的医院没有发现重大变化。

结论

与使用标准 Macintosh 喉镜相比，使用 Macintosh 式视频喉镜作为手术室气管插管的首选设备与容易气管插管的比例显着增加有关。