Abstract：
OBJECTIVE: The objective of our study was to compare the degree of difficulty and complications related to tracheal intubation in an Intensive Care Unit (ICU) before and after the introduction of an intubation protocol based on the Difficult Airway Society guidelines for the management of tracheal intubation in critically ill adults, published in 2018.
METHODS: Prospective, observational study comparing all intubations performed in our ICU over 2 periods: pre-protocol (January 2015-January 2019) and post-protocol (February 2019-July 2022). The material used for intubation, the degree of difficulty, and intubation-related complications were recorded.
RESULTS: During the study period, 661 patients were intubated - 437 in the pre-protocol period (96% by direct laryngoscopy) and 224 in the post-protocol period (53% with direct laryngoscopy, 46% with video laryngoscopy). We observed an improvement in laryngeal view in the post-protocol period compared to the pre-protocol period (Cormack-Lehane ≥ 2b in 7.6% vs. 29.8%, p < 0.001), and a decrease in the number of moderate-to-severely difficult intubations (6.7% vs. 17.4%, p < 0.001). The first-pass success rate was 92.8% in the post-protocol period compared to 90.2% pre-protocol (p = 0.508). We did not find significant differences in complications between the periods studied.
CONCLUSIONS: Intubations performed in the post-protocol period were associated with improved laryngeal view and fewer cases of difficult intubation compared with the pre-protocol period.
METHODS: Prospective, observational study comparing all intubations performed in our ICU over 2 periods: pre-protocol (January 2015-January 2019) and post-protocol (February 2019-July 2022). The material used for intubation, the degree of difficulty, and intubation-related complications were recorded.
RESULTS: During the study period, 661 patients were intubated - 437 in the pre-protocol period (96% by direct laryngoscopy) and 224 in the post-protocol period (53% with direct laryngoscopy, 46% with video laryngoscopy). We observed an improvement in laryngeal view in the post-protocol period compared to the pre-protocol period (Cormack-Lehane ≥ 2b in 7.6% vs. 29.8%, p < 0.001), and a decrease in the number of moderate-to-severely difficult intubations (6.7% vs. 17.4%, p < 0.001). The first-pass success rate was 92.8% in the post-protocol period compared to 90.2% pre-protocol (p = 0.508). We did not find significant differences in complications between the periods studied.
CONCLUSIONS: Intubations performed in the post-protocol period were associated with improved laryngeal view and fewer cases of difficult intubation compared with the pre-protocol period.
摘要：
目的：我们的研究目的是比较重症监护病房（ICU）中气管插管的难度和并发症的程度，该导管基于困难气道协会指南在危重病成人气管插管管理中引入插管方案之前和之后，发布于2018年。
方法：前瞻性，观察性研究比较了ICU中2个时期的所有插管:方案前(2015年1月-2019年1月)和方案后(2019年2月-2022年7月).用于插管的材料，难度,并记录插管相关并发症。
结果：在研究期间，661例患者接受了插管-437例在方案前阶段（96％通过直接喉镜检查）和224在方案后阶段（53％通过直接喉镜检查，46%与视频喉镜)。我们观察到与方案前相比，方案后时期喉部视图有所改善（Cormack-Lehane≥2b，分别为7.6％和29.8％，p<0.001)，中度至重度困难插管的数量减少(6.7%对17.4%，p<0.001)。方案后阶段的首过成功率为92.8％，而方案前的成功率为90.2％（p=0.508）。我们没有发现研究期间的并发症有显著差异。
结论：与方案前相比，在方案后时期进行的插管与改善的喉部视图和较少的困难插管病例相关。
方法：前瞻性，观察性研究比较了ICU中2个时期的所有插管:方案前(2015年1月-2019年1月)和方案后(2019年2月-2022年7月).用于插管的材料，难度,并记录插管相关并发症。
结果：在研究期间，661例患者接受了插管-437例在方案前阶段（96％通过直接喉镜检查）和224在方案后阶段（53％通过直接喉镜检查，46%与视频喉镜)。我们观察到与方案前相比，方案后时期喉部视图有所改善（Cormack-Lehane≥2b，分别为7.6％和29.8％，p<0.001)，中度至重度困难插管的数量减少(6.7%对17.4%，p<0.001)。方案后阶段的首过成功率为92.8％，而方案前的成功率为90.2％（p=0.508）。我们没有发现研究期间的并发症有显著差异。
结论：与方案前相比，在方案后时期进行的插管与改善的喉部视图和较少的困难插管病例相关。
