Kev txheeb xyuas nyiaj txiag ntawm kev siv video laryngoscopy piv rau direct laryngoscopy hauv qhov chaw phais

Abstract

Ntsiab lus:

• ncaj qha laryngoscopy
• kev txheeb xyuas nyiaj txiag kev noj qab haus huv
• tus nqi tsev kho mob
• tsev kho mob intensive
• ntev nyob
• tracheal intubation
• video laryngoscopy

Laryngoscopy thiab tracheal tube tso yog txheej txheem txheej txheem uas tsis tshua muaj tab sis muaj teeb meem loj.Hauv xyoo 2010, nws tau kwv yees tias cov raj tracheal tau siv thaum lub sijhawm 15 lab kev phais hauv Tebchaws Meskas [1].Nyuaj thiab ua tsis tiav intubation tshwm sim tsawg dua 6% thiab 0.3% ntawm cov neeg mob, feem, thiab feem ntau yuav tshwm sim thaum muaj xwm txheej ceev lossis kev saib xyuas hnyav dua li hauv chav ua haujlwm [2,3].Txawm hais tias lawv qhov xwm txheej tsis tshua muaj, thaum muaj teeb meem cuam tshuam nrog kev nyuaj thiab ua tsis tiav intubation tshwm sim, lawv tuaj yeem hloov tsis tau thiab tuag taus [4].Hauv kev tshawb fawb hauv Asmeskas, 2.3% ntawm cov tshuaj loog hais txog kev tuag yog vim kev ua tsis tiav lossis nyuaj intubation [5].Yog li ntawd, kev txheeb xyuas cov kev txhim kho kom nce tracheal intubation txoj kev vam meej thiab kev nyab xeeb yog qhov tseem ceeb rau cov tsev kho mob.

Kev taw qhia ntawm video laryngoscopy (VL) rau hauv kev kho mob yog ib qho tseem ceeb ua ntej.Tsis zoo li direct laryngoscopy (DL) uas tso siab rau txoj kab ncaj nraim ntawm kev pom mus rau qhov qhib glottic, VL siv txoj hauv kev tsis ncaj, xa cov duab los ntawm cov hniav lub taub rau kev txhim kho kev pom ntawm qhov qhib glottic.Ntau cov kev tshawb fawb tau pom tias VL txo qhov tshwm sim ntawm qhov nyuaj intubation thiab zoo dua rau cov neeg mob uas tau kwv yees txoj hlab ntsws nyuaj [3].Kev siv VL tau pom zoo ntau ntxiv hauv cov txheej txheem hauv kev ua pa raws li cov txheej txheem kev tso ntshav thiab ua kev cawm siav thaum DL ua tsis tau [6,7].Feem ntau ntawm cov xwm txheej nyuaj intubation yog npaj txhij txog txawm tias muaj kev ntsuam xyuas txaus [4,8,9].Yog li ntawd, tej zaum tus nqi ntawm kev siv VL raws li ib tug thawj-kab mus kom ze yog lub ntsiab lus sib tham [10–14].

Qhov kev tshawb nrhiav rov qab los ntawm pawg neeg no tau ua los txheeb xyuas cov txiaj ntsig kev kho mob thiab nyiaj txiag ntawm VL piv rau DL hauv pawg neeg mob hauv chav ua haujlwm.Txoj kev tshawb no tau siv Premier Healthcare Database, sawv cev txog li 25% ntawm kev nkag mus rau hauv Tebchaws Meskas txhua xyoo.Nws suav nrog ntau tus neeg mob, hom kev phais mob thiab ib puag ncig hauv tsev kho mob, ua rau nws muaj txiaj ntsig zoo los sib piv cov txiaj ntsig ntawm cov txheej txheem sib txawv xws li DL thiab VL.Cov kev tshawb pom tuaj yeem yog cov ntaub ntawv qhia rau cov kws kho mob xav txog seb VL yuav tsum raug txiav txim siab dhau DL li cas rau lwm txoj hauv kev tracheal intubation.

Cov ntaub ntawv & txoj kev

Kawm tsim qauv

Peb tau ua ib txoj kev tshawb nrhiav kev soj ntsuam rov qab siv 3 xyoo ntawm cov ntaub ntawv (2016-2018) los ntawm Premier Healthcare Database.Premier Healthcare Database raug suav hais tias raug zam los ntawm Pawg Saib Xyuas Kev Tshawb Fawb Hauv Lub Tsev Haujlwm raws li tau hais los ntawm Title 45 Code of Federal Regulations, Part 46 of the US, tshwj xeeb 45 CFR 46.101(b) (4).Raws li Txoj Cai Kev Pov Hwm Kev Noj Qab Haus Huv Portability thiab Accountability Act Privacy Rule, cov ntaub ntawv tshaj tawm los ntawm Premier raug suav tias yog de-identified per 45 CFR 164.506(d)(2)(ii)(B) los ntawm 'Kev Txiav Txim Siab' txoj kev.

Kev xaiv pawg

Txhua tus neeg laus cov neeg mob uas tau xaiv txoj kev phais hauv tsev kho mob nrog tsawg kawg 1 h ntawm cov tshuaj loog dav dav thiab tracheal intubation (muaj lo lus tseem ceeb ntawm 'intubation' nyob rau hauv tus nqi master file) tau nug (n = 72,284,Daim duab 1).Qhov yuav tsum tau muaj rau 1 h ntawm kev siv tshuaj loog yog npaj los tshem tawm cov neeg mob uas tau txais kev phais me me.Cov xwm txheej kub ntxhov thiab cov neeg mob cev xeeb tub tau raug cais tawm vim tias cov kev kho mob thiab cov neeg mob yuav txawv ntawm cov neeg uas muaj kev xaiv phais.Cov neeg mob tau muab faib ua 25 pawg kuaj mob loj (MDC) raws li lawv pawg kuaj mob ntsig txog (DRG).Cov pab pawg kawg suav nrog cov neeg laus hauv kaum pawg MDC, uas suav txog 86.2% ntawm cov neeg laus xaiv cov neeg mob phais (n = 62,297/72,284,Daim duab 1).

 

Raws li hom laryngoscope siv rau intubation, cohort tau muab cais ua pawg DL thiab VL.Kev tshawb nrhiav lo lus tseem ceeb los ntawm cov ntaub ntawv tus thawj coj tau siv los txheeb xyuas lub laryngoscope (DL vs VL).Cov ntsiab lus suav nrog kev sib xyaw ntawm cov chaw tsim khoom lub npe, lub npe hniav, qhov loj, hom thiab cov kab lus 'video laryngoscopy' lossis 'direct laryngoscopy' thiab lawv cov ntawv luv (Cov lus ntxiv 1).Tus kws tshaj lij them nyiaj rov qab tau tshuaj xyuas cov npe ntawm cov lus tseem ceeb thiab lees paub qhov tseeb ntawm categorization.Cov neeg mob uas tsis muaj ntaub ntawv ntawm hom laryngoscopy siv tau raug xa mus rau pawg DL.Qhov no tau ua vim tias DL feem ntau tau ntim rau hauv kev qhia tshuaj loog tag nrho thiab yog li tsis tau tshaj tawm.Muaj ntau tus neeg mob tau txais DL piv nrog cov neeg tau txais VL hauv peb pawg (n = 55,320 vs 6799).Yog li ntawd, cov neeg mob tau txais DL raug xaiv nyob rau hauv txhua pawg MDC ntawm qhov sib piv ntawm 3: 1 (DL: VL), txhawm rau txo tus qauv qhov tsis sib xws ntawm pawg thaum tswj tus neeg mob thiab tsev kho mob yam ntxwv ntawm thawj pawg DL [15,16].Hauv pawg pob ntseg, qhov ntswg, qhov ncauj, thiab caj pas MDC, qhov sib piv yog 2: 1 DL: VL vim tias pawg DL tsawg dhau los ua kom muaj qhov sib piv 3: 1.

Kev soj ntsuam rhiab heev

Txhawm rau kom ntseeg tau tias qhov sib txawv ntawm cov pab pawg tsis yog vim qhov tsis ncaj ncees ntawm cov neeg mob uas tau lees paub DL, kev soj ntsuam rhiab heev tau ua.Hauv qhov kev tshuaj ntsuam no, kev txwv ntawm 1 h ntawm lub sijhawm phais raug tshem tawm kom suav nrog ntau tus neeg mob DL.Ib txoj hauv kev zoo sib xws tau siv los sib npaug ntawm tus neeg mob qhov chaw kho mob thiab tsev kho mob cov yam ntxwv ntawm DL thiab VL pawg ntawm txhua qib MDC.Ib tus neeg mob hauv pawg DL tau nyob hauv tsev kho mob ntev (472 hnub) thiab tsis suav nrog kev tshuaj xyuas.Tus neeg mob no muaj mob neurologic thiab qaug dab peg (thawj ICD_10 kev kuaj mob code: G40.909), thiab nyob rau hnub tsev kho mob #123 tau txais kev kho mob tracheotomy thiab tso cov cuab yeej tracheostomy (ICD_10 tus txheej txheem phais code: 0B110F4).

Cov txiaj ntsig ntsuas

Cov txiaj ntsig tseem ceeb suav nrog tag nrho cov nqi kho mob hauv tsev kho mob, qhov ntev ntawm kev nyob hauv tsev kho mob (LOS), tom qab kev kho mob hnyav (ICU) tus nqi nkag thiab cov teeb meem tom qab phais.Kev nkag mus rau ICU tom qab tau txiav txim siab raws li cov neeg mob tau mus rau ICU hnub lossis tom qab hnub phais.Cov teeb meem tom qab kev phais raug txheeb xyuas siv ICD-10 cov lej rau kev mob ntsws ntsws (J15, J18), mob plawv (I20, I21, I24, I46), mob ua pa (J98.1, J95.89) thiab lwm yam teeb meem ntawm kev kho mob phais (T88). ) (Cov lus ntxiv 2).

Kev txheeb cais

Kev tshuaj xyuas Univariate tau siv los sib piv cov neeg mob hauv cov pej xeem, cov yam ntxwv kho mob thiab cov yam ntxwv hauv tsev kho mob.Chi-square test los yog Fisher qhov tseeb qhov kev xeem tau siv rau qhov sib txawv ntawm categorical thiab Wilcoxon test rau qhov sib txawv tsis tu ncua.p-tus nqi yog ob-taw nrog qhov tseem ceeb ntawm kev txheeb cais ntawm p <0.05.

Kev hloov kho tus nqi sib txawv ntawm tus neeg mob tau kwv yees siv qhov kev kwv yees dav dav (GEE) qauv nrog gamma tis.Qhov hloov kho qhov ntev ntawm qhov sib txawv nyob ntawm qhov sib txawv tau kwv yees siv GEE qauv nrog Poisson faib.Multivariable logistic regressions tau ua los kwv yees qhov sib txawv ntawm kev ua haujlwm tom qab ICU tus nqi thiab tus nqi cuam tshuam.Txij li cov teeb meem tsis tshua muaj tsawg, Firth qhov kev nplua zoo li yuav raug siv los txo qis cov qauv me me hauv qhov kev kwv yees siab tshaj plaws hauv cov qauv logistic regression.Txhua tus qauv tswj hwm tus yam ntxwv ntawm tus neeg mob, suav nrog cov neeg mob hnub nyoog, poj niam los txiv neej, haiv neeg, kev ua txij ua nkawm, Charlson comorbidity index thiab thawj kev tuav pov hwm, thiab cov yam ntxwv hauv tsev kho mob, suav nrog kev qhia hauv tsev kho mob, txaj loj, thaj chaw hauv tsev kho mob thiab qhov chaw.Txhua qhov kev txheeb xyuas txheeb cais tau ua tiav siv SAS Version 9.4 (SAS Institute Inc., NC, USA).

Cov txiaj ntsig

Tus neeg mob & tsev kho mob yam ntxwv

Tag nrho ntawm 62,297 tus neeg mob ua tau raws li txoj kev tshawb fawb xaiv.Tom qab 1: 3 (VL: DL) random xaiv los ntawm pawg DL (1: 2 VL: DL rau Cov Kab Mob ntawm Pob Ntseg, Qhov ntswg, Qhov ncauj thiab caj pas MDC pawg), pawg neeg zaum kawg muaj 6799 tus neeg mob tau txais VL thiab 20,867. cov neeg mob tau txais DL (Daim duab 1).

Cov neeg mob pej xeem thiab cov yam ntxwv kho mob, thiab cov yam ntxwv hauv tsev kho mob ntawm cov neeg mob hauv pawg VL thiab DL, tau qhia hauvTable 1.Piv nrog rau pawg DL, cov neeg mob uas tau txais VL muaj hnub nyoog qis dua (nruab nrab hnub nyoog 60.9 xyoo vs 61.5 xyoo, p = 0.0007), ntau dua yuav txiv neej (52.5% [n = 3666/6977] vs 45.1% [n = 9412/ 20,867], p < 0.0001) thiab Caucasian (80.4% [n = 5609/6977] vs 76.2% [n = 15,902/20,867], p < 0.0001).Piv nrog rau pawg DL, cov neeg mob hauv pawg VL feem ntau yuav tau mus rau hauv tsev kho mob uas nyob deb nroog thiab cov tsev qhia ntawv (18.9% [n = 1321/6977] vs 11.8% [n = 2463/20,867], p < 0.0001 thiab 42.6% [n = 2972/6977] vs 28.9% [n = 6038/20,867], p < 0.0001, ntsig txog), thiab uas yog nyob rau thaj tsam Midwest thiab West (26.1% [n = 1820/6977] vs 5.3% [n = 1101/20,867], p < 0.0001 thiab 24.8% [n = 1731/6977] vs 7.2% [n = 1506/20,867], p < 0.0001, ntsig txog).Qhov nruab nrab lub sij hawm tshuaj loog yog ntev dua nyob rau hauv pawg VL (227 min vs 218 min, p < 0.0001).Kev faib tawm ntawm cov neeg mob thoob plaws MDC pawg tau zoo sib xws ntawm pawg VL thiab DL (p = 0.6122).

Tag nrho cov nqi kho mob

Tom qab tswj hwm cov neeg mob pej xeem thiab kho mob thiab tsev kho mob cov yam ntxwv, piv nrog DL pawg, VL pawg tau qis dua qhov nruab nrab tag nrho cov nqi kho mob hauv yim tawm ntawm kaum MDC pawg (Daim duab 2A).Tus nqi sib txawv ntawm pawg VL thiab DL yog li ntawm $ 1144 txog $ 5891 thoob plaws yim pawg MDC.Cov pab pawg MDC uas qhov qis tshaj plaws thiab kev txuag nyiaj ntau tshaj plaws nyob rau hauv nruab nrab tag nrho cov nqi kho mob yog Cov Kab Mob thiab Kab Mob ntawm Cov Txiv Neej Reproductive System pab pawg ($ 13,930 vs $ 15,074, p < 0.032), thiab Kab Mob thiab Kab Mob ntawm Pob ntseg, Qhov ntswg, Qhov ncauj thiab caj pas. ($ 13,485 vs $19,376, p < 0.0001), feem.Tsis muaj qhov sib txawv tau pom nyob rau hauv nruab nrab tag nrho cov nqi kho mob hauv nruab nrab ntawm VL thiab DL pawg hauv Cov Kab Mob thiab Kab Mob ntawm Circulatory System MDC pawg ($ 45,594 vs $ 44,155, p = 0.1758).

Hauv kev tshuaj xyuas tsis raug kho, piv nrog DL pawg, VL pawg muaj tus nqi qis dua nruab nrab ntawm tus neeg mob hauv peb ntawm kaum pawg MDC (Daim duab 2B).Cov no yog cov kab mob thiab cov kab mob ntawm lub plab zom mov ($ 21,021 vs $ 24,121, p = 0.0007), cov kab mob thiab cov kab mob ntawm lub ntsws ($ 25,848 vs $ 31,979, p = 0.0005), thiab kab mob thiab kab mob ntawm pob ntseg, qhov ntswg, qhov ncauj thiab caj pas ($15,886 vs $21,060, p = 0.017) MDC pawg.Tus nqi nruab nrab ntawm tus neeg mob tsis raug kho yog siab dua hauv pawg VL piv nrog DL pawg hauv ob pawg MDC;cov kab mob thiab kev tsis sib haum xeeb ntawm cov txiv neej kev laus ($ 13,891 vs $ 11,970, p = 0.0019) thiab cov kab mob thiab cov kab mob ntawm cov poj niam cev xeeb tub ($ 14,367 vs $ 12,041, p = 0.003).

Ntev nyob

Tom qab tswj hwm cov neeg mob pej xeem thiab kho mob thiab tsev kho mob cov yam ntxwv, piv nrog DL pawg, VL pab pawg tau hloov kho lub tsev kho mob luv luv LOS hla cuaj ntawm kaum pawg MDC.Qhov nruab nrab LOS qhov sib txawv yog qhov tseem ceeb hauv yim ntawm kaum MDC pawg (Daim duab 3A).Qhov kev txo qis hauv qhov nruab nrab LOS yog ntau dua 1 hnub hauv tsib pawg MDC, suav nrog cov kab mob thiab cov kab mob ntawm pob ntseg, qhov ntswg, qhov ncauj thiab caj pas (3.2 hnub vs 4.6 hnub, p <0.0001), thiab cov kab mob thiab cov kab mob ntawm lub plab zom mov. (8.0 hnub vs 9.4 hnub, p <0.0001).

Qhov nruab nrab LOS tsis hloov pauv tau luv luv hauv VL pawg hauv ob ntawm kaum MDC pawg, cov kab mob thiab cov kab mob ntawm cov leeg nqaij thiab cov nqaij sib txuas (2.8 vs 3.0 hnub, p = 0.0011) thiab cov kab mob thiab cov kab mob ntawm lub plab zom mov (6.0 vs. 7.0 hnub, p = 0.0004).Tsis muaj qhov sib txawv tseem ceeb hauv qhov nruab nrab LOS uas tsis tau hloov kho rau lwm pawg MDC (Daim duab 3B).

Postoperative ICU tus nqi

Ntawm kev nkag mus rau ICU tom qab, 90.1% (n = 878/975), thiab 87.4% (n = 3077/3521) tshwm sim nyob rau hauv 1 hnub ntawm cov txheej txheem phais hauv pawg VL thiab DL, feem.

Tom qab tswj hwm tus neeg mob cov pej xeem thiab cov yam ntxwv hauv tsev kho mob thiab tsev kho mob, qhov tshwm sim ntawm kev nkag mus rau ICU tom qab tau qis dua (p <0.05) rau pawg VL dua li DL pawg hauv txhua kaum MDC pawg.Qhov kev hloov pauv qhov sib txawv ntawm kev nkag mus rau ICU tom qab tau nyob ntawm 0.04 txog 0.68 (Rooj 2).

Qhov nruab nrab tsis hloov pauv tom qab ICU nkag tau qis dua nrog VL dua DL hla rau ntawm kaum ntawm MDC pawg.Qhov sib txawv ntawm kev nkag mus rau qhov sib txawv ntawm 0.8 mus rau 25.5%, nrog qhov sib txawv loj tshaj plaws ntawm cov kab mob thiab cov kab mob ntawm pob ntseg, qhov ntswg, qhov ncauj thiab caj pas pawg (VL vs DL, 17.6% [n = 12/68], vs 43.1% [ n = 59/137], p = 0.0003).Tsis muaj qhov sib txawv ntawm qhov nruab nrab tom qab ICU nkag mus kawm tau pom nyob rau hauv plaub pawg MDC ntxiv (Table 3).

Teeb meem

Tom qab tswj hwm tus neeg mob cov pej xeem thiab cov yam ntxwv hauv tsev kho mob thiab tsev kho mob, qhov ua tau ntawm cov teeb meem perioperative tau qis dua nrog VL piv nrog DL hauv ntau pawg MDC.Muab piv rau cov neeg mob tau txais VL rau cov neeg mob tau txais DL, qhov ua rau muaj tus kab mob pulmonary tsawg dua hauv peb pawg MDC, suav nrog cov kab mob thiab cov kab mob ntawm cov kab mob: digestive system;musculoskeletal system thiab connective ntaub so ntswg;thiab endocrine, khoom noj khoom haus thiab metabolic system (LOSSIS: 0.56, LOSSIS: 0.49 thiab OR: 0.30; p = 0.03123, p = 0.02996, thiab p = 0.00441, ntsig txog);muaj cov teeb meem ntawm cov hlab plawv tau qis dua hauv 6 pawg MDC, suav nrog cov kab mob thiab cov kab mob ntawm cov kab mob: ua pa;digestive system;musculoskeletal system thiab connective ntaub so ntswg;endocrine, noj zaub mov thiab cov kab mob metabolic;lub raum thiab tso zis;thiab poj niam cev xeeb tub (OR: 0.28, OR: 0.3, OR: 0.21, OR: 0.12, OR: 0.11 thiab OR: 0.12; p = 0.00705, p = 0.00018, p = 0.00370, p = 0.00370, p < 0.08 p. = 0.007, raws);muaj teeb meem ua pa qis dua hauv peb pawg MDC, suav nrog cov kab mob thiab cov kab mob ntawm cov kab mob: circulatory system;hepatobiliary system thiab pancreas;thiab endocrine, khoom noj khoom haus thiab metabolic system (LOSSIS: 0.66, LOSSIS: 0.90 thiab OR: 0.43, p = 0.00415, p < 0.0001 thiab p = 0.03245, ntsig txog);muaj lwm yam kev phais/kev kho mob tsis zoo nyob rau hauv ib pawg MDC, cov kab mob thiab cov kab mob ntawm lub hepatobiliary system thiab pancreas (LOSSIS: 0.9, p < 0.0001) thiab siab dua nyob rau hauv ib pawg MDC, cov kab mob thiab cov kab mob ntawm cov poj niam cev xeeb tub (los yog: 16.04, PIB = 0.00141)Rooj 4).

Hauv cov kab mob thiab kev tsis sib haum xeeb ntawm pawg MDC, qhov tsis hloov pauv ntawm cov teeb meem ua pa tsis zoo tau qis dua hauv pawg VL piv nrog DL pawg (10.8% [n = 71/656], vs 15.5% [n = 305/1968] ], np = 0.003).Nyob rau hauv cov kab mob thiab kev tsis haum xeeb ntawm lub plab zom mov MDC pawg thiab cov kab mob musculoskeletal thiab cov ntaub so ntswg MDC pawg, qhov tsis hloov kho ntawm cov teeb meem hauv plawv tau qis dua hauv pawg VL piv nrog DL pawg (1.3% [n = 11/825], vs 3.7% [n = 91/2475], p = 0.008; thiab 0.6% [n = 27/3725], vs 1.2% [n = 137/11,176], p = 0.003, ntsig txog).Tsis muaj lwm qhov sib txawv tseem ceeb hauv cov teeb meem uas tsis tau hloov kho ntawm pawg VL thiab DL nrog rau lwm pawg MDC (Table 5).

Kev soj ntsuam rhiab heev

Tag nrho ntawm 88 tus neeg mob DL thiab 264 tus neeg mob VL tau suav nrog hauv kev tshuaj ntsuam rhiab heev.Qhov ntau ntawm LOS yog 1–106 hnub rau pawg VL, thiab 1–71 hnub rau pawg DL, hla kaum pawg MDC.Cov pab pawg VL muaj lub tsev kho mob luv luv LOS (11.2 vs 14.7 hnub, p = 0.049), thiab qis dua nruab nrab tom qab ICU nkag tus nqi (49.2% [n = 130/264], vs 61.4% [n = 54/88], p = 0.049) piv nrog DL pawg.Qhov nruab nrab tag nrho cov nqi kho mob tau qis dua hauv pawg VL piv nrog DL pawg, txawm hais tias qhov sib txawv tsis tseem ceeb ($ 56,384 vs $ 57,287, p = 0.913).Tsis muaj qhov sib txawv tseem ceeb hauv cov txiaj ntsig ntawm VL thiab DL (Table 6).

Kev sib tham

Laryngoscopy rau tracheal intubation feem ntau cuam tshuam nrog cov teeb meem, tab sis thaum muaj teeb meem tshwm sim, lawv tuaj yeem ua rau mob hnyav, tuag taus thiab hloov tsis tau.Nyuaj thiab ua tsis tiav intubations cuam tshuam nrog cov txiaj ntsig tsis zoo, suav nrog hypoxemia, bronchospasm, kev raug mob ntawm txoj hlab ntsws, kub siab, arrhythmias, plawv nres, neurologic puas, tsis npaj ICU nkag thiab tuag [4,17].Tus nqi ntawm qhov nyuaj thiab ua tsis tiav intubation tau txo qis hauv xyoo tas los no raws li cov lus qhia tshiab thiab cov cuab yeej siv tau raug qhia rau hauv kev kho mob [18].Nws yog ib qho tseem ceeb los mus txuas ntxiv kev siv zog ua kom muaj kev nyab xeeb ntawm laryngoscopy thiab tracheal intubation.

Ntau qhov kev tshawb fawb tau pom tias VL muab kev pom zoo dua qub thiab txo cov naj npawb ntawm kev ua tsis tiav intubation sim piv nrog DL [3].Ib xyoo 2016 Cochrane tshuaj xyuas ntawm 38 qhov kev sim uas muaj 4127 tus neeg koom tau xaus lus tias VL txo qhov zaus ntawm kev ua tsis tiav intubations piv nrog DL [3].Qhov txo qis ntawm kev ua tsis tiav intubations yog qhov tseem ceeb tshwj xeeb hauv kev tshawb fawb ntawm cov neeg mob uas xav tau los yog simulated nyuaj airways [3].VL tau pom zoo nyob rau hauv ntau txoj kev qhia dav hlau [7,19,20], thiab nws feem ntau siv thiab tau pom tias muaj kev vam meej siab thaum siv los ua kev cawm seej tom qab DL tsis ua haujlwm [6,11,21].Txawm li cas los xij, txawm hais tias kev siv zog los txheeb xyuas cov kab mob nyuaj ua ntej intubation, feem ntau nyuaj intubations tsis tau xav txog [4,8,9,22].Qhov no qhia tau tias muaj txiaj ntsig zoo rau kev siv VL txawm tias nyuaj intubation tsis tau xav txog [10,11].VL tau txais kev pom zoo ntxiv thiab siv los ua ib feem ntawm thawj kab tswv yim hauv cov xwm txheej niaj hnub intubation [10,13,23,24[25].

Kev nkag siab me ntsis txog qhov cuam tshuam ntawm VL thiab DL ntawm cov txiaj ntsig kev noj qab haus huv rau cov neeg mob uas tau txais cov txheej txheem phais mob hauv tsev kho mob.Ib txoj kev tshawb fawb los ntawm Alsumali thiab cov npoj yaig siv cov qauv txiav txim siab simulated pom tias VL tau cuam tshuam nrog kev txo qis ntawm cov xwm txheej tsis zoo thiab muaj $ 3429 khaws tseg rau ib qho xwm txheej tsis zoo uas zam hauv chav ua haujlwm [26].Lwm qhov kev tshawb fawb rov qab los ntawm Moucharite thiab cov npoj yaig tau pom tias nyuaj thiab ua tsis tiav intubations kuj cuam tshuam nrog tus nqi kho mob siab dua thiab ntev LOS [27].Lub hom phiaj ntawm txoj kev tshawb fawb tam sim no yog txhawm rau txheeb xyuas cov ntaub ntawv hauv ntiaj teb tiag tiag los ntawm Premier Healthcare Database, sawv cev kwv yees li 25% ntawm tag nrho Asmeskas cov neeg mob nkag mus, txhawm rau ua tiav qhov sib txawv no.Qhov qauv loj loj no tso cai rau lub zog txaus rau kev kawm txog cov teeb meem tsis sib xws ntawm tracheal intubation.Txij li cov txheej txheem nyuaj, tus nqi thiab cov txiaj ntsig ntawm tus neeg mob yuav tsum sib txawv ntawm cov pab pawg MDC, qhov kev tshuaj ntsuam tau ntxiv dag zog los ntawm kev ua cov kev sib piv ntawm MDC pawg.Cov pab pawg MDC tau tsim los ntawm kev faib tag nrho cov kev kuaj mob tseem ceeb rau hauv 25 qhov chaw kuaj mob tshwj xeeb.Cov kev kuaj mob hauv txhua MDC sib raug rau ib qho kab mob hauv nruab nrog cev lossis etiology thiab feem ntau cuam tshuam nrog kev kho mob tshwj xeeb.Kev kho mob feem ntau yog ua raws li cov kab mob hauv nruab nrog cev cuam tshuam.Siv cov pab pawg MDC pab peb txwv cov txheej txheem phais mob uas tsis muaj kev txwv qhov kev tshuaj xyuas rau cov kev phais tshwj xeeb.

Thaum muab piv rau tus neeg mob thiab tsev kho mob cov yam ntxwv ntawm cov neeg mob tau txais DL lossis VL, peb pom ntau qhov sib txawv tseem ceeb.Cov neeg mob uas tseem yau, txiv neej lossis neeg Caucasian feem ntau yuav tau txais VL, thiab cov neeg mob hauv tsev kho mob qhia lossis hauv thaj tsam Midwest lossis West US feem ntau yuav tau txais VL.Qhov sib txawv ntawm kev siv VL yuav cuam tshuam tsis tsuas yog qhov sib txawv ntawm qhov xav tau siv VL rau cov neeg mob tshwj xeeb, tab sis kuj tseem tuaj yeem cuam tshuam kev siv cov cuab yeej tshiab thiab kev cob qhia sai dua nyob ntawm kev qhia muaj peev xwm ntawm lub tsev kho mob thiab nws qhov chaw nyob hauv cheeb tsam.Ib yam li ntawd, qhov sib txawv ntawm VL siv thoob plaws txhua haiv neeg tuaj yeem cuam tshuam qhov sib txawv ntawm tus kheej nyiam thiab cov yam ntxwv hauv tsev kho mob, suav nrog qhov loj, thaj tsam thiab kev muaj peev xwm qhia.Ntxiv nrog rau kev tswj hwm rau ntau yam ntawm tus neeg mob thiab tsev kho mob tus yam ntxwv, kev tshuaj xyuas ntau yam tswj tau rau lub sijhawm tshuaj loog, qhov muaj peev xwm ntawm qhov nyuaj.

Txoj kev tshawb no tau pom cov txiaj ntsig kev noj qab haus huv tau zoo dua nrog VL piv nrog DL hauv cov neeg mob uas tau xaiv txoj kev phais mob hauv tsev kho mob thiab lees paub qhov kev tshawb pom ntawm Alsumali.ua al.[26].Qhov nruab nrab tag nrho cov nqi kho mob tau qis dua rau cov neeg mob kho nrog VL dua li DL hauv yim ntawm kaum pawg MDC.Tus nqi txuag rau ib tus neeg mob nyob hauv qhov xwm txheej yog li ntawm $ 1144 txog $ 5891, nyob ntawm pawg MDC.Cov nqi txo qis tuaj yeem cuam tshuam cov txiaj ntsig ntawm tus neeg mob tau zoo dua qub, vim tias VL kuj tseem cuam tshuam nrog lub tsev kho mob luv luv LOS, nrog rau qhov nruab nrab nyob yuav raug txo kom ntau tshaj 1 hnub hauv ib nrab ntawm MDC pawg.Qhov tseem ceeb, qhov ua tau ntawm kev nkag mus rau ICU tom qab tau qis dua rau VL dua DL thoob plaws kaum pawg MDC.VL kuj tseem cuam tshuam nrog qhov qis dua ntawm cov hlab plawv thiab ua pa nyuaj hauv rau thiab peb ntawm kaum pawg MDC, raws li.Zuag qhia tag nrho, qhov kev tshuaj ntsuam no qhia txog cov txiaj ntsig dav dav rau kev siv VL rau cov txheej txheem phais xaiv hauv qhov chaw kho mob hauv tsev kho mob, cuam tshuam txog cov nqi txo qis, luv luv LOS thiab txo qhov yuav muaj teeb meem thiab kev nkag mus rau ICU tom qab.

Peb lees paub ntau qhov kev txwv ntawm txoj kev kawm.Ua ntej, nws yog kev tshuaj xyuas rov qab ntawm cov ntaub ntawv siv rau kev tswj hwm lub hom phiaj, kev them nqi thiab kev them rov qab.Tsis muaj CPT / HCPCS lossis ICD-10 cov txheej txheem phais mob kom ncaj qha txheeb xyuas cov txheej txheem intubation siv thaum txhua txoj kev phais.Txoj kev tshawb nrhiav lo lus tseem ceeb yuav ua tsis tiav los txheeb xyuas tag nrho cov neeg mob vim qhov tsis tiav ntawm cov npe lo lus tseem ceeb lossis tsev kho mob tsis tau tshaj tawm cov ntsiab lus vim yog cov nyiaj them poob haujlwm ntawm kev kho mob niaj hnub.Hauv txoj kev tshawb no, peb pom tias cov txheej txheem DL tau raug tshaj tawm tsis zoo.Kev suav nrog cov neeg mob hauv pawg DL uas nws lub tsev kho mob cov nqi them nqi tsis tau qhia txog hom laryngoscopy tuaj yeem ua rau qee cov neeg mob tau txais VL li DL, ua rau muaj kev sib txawv ntawm pawg DL thiab ua rau qhov sib txawv ntawm cov pab pawg nyuaj nrhiav pom.Peb tau ua qhov kev soj ntsuam rhiab heev uas siv cov ntaub ntawv VL thiab DL uas tau lees paub los daws qhov kev txwv no, uas ua rau muaj kev tshawb pom zoo sib xws.Nws kuj tseem muaj peev xwm hais tias qee cov neeg mob uas muaj cov kab mob hauv cov hlab ntsws uas tuaj yeem tau txais txiaj ntsig los ntawm VL tau txais DL, muaj peev xwm ua rau muaj qhov tshwm sim, nrog rau qhov sib txawv ntawm qhov tshwm sim, ntawm cov teeb meem tom qab phais hauv pawg DL.Qhov tseem ceeb, peb qhov kev soj ntsuam ntawm kev tswj hwm cov ntaub ntawv yog nyob ntawm cov ntaub ntawv tiag tiag, nrog cov neeg mob tau txais cov qauv kev saib xyuas hauv tsev kho mob.Yog li ntawd, qhov tshwm sim qis dua ntawm cov teeb meem hauv cov neeg mob nrog VL pom hauv txoj kev tshawb no qhia txog qhov xwm txheej tiag tiag uas tshwm sim hauv qhov chaw phais, tsis hais seb VL yuav tsum siv rau cov neeg mob tshwj xeeb uas muaj cov kab mob hauv lub ntsws.Tsis tas li ntawd, txawm hais tias peb tau txheeb xyuas cov neeg mob los ntawm pawg MDC, txhua pawg MDC suav nrog ntau cov txheej txheem uas tuaj yeem cuam tshuam cov neeg mob tau txais txiaj ntsig, qhov ntev ntawm kev nyob thiab cov nqi.Peb qhov kev tshuaj ntsuam xyuas yog tsom mus rau qhov nruab nrab tus neeg mob hauv txhua pawg MDC, tsis zoo li cov txheej txheem tshwj xeeb, uas tuaj yeem muaj qhov hloov pauv loj hauv cov txiaj ntsig kev noj qab haus huv.Cov kev tshawb fawb yav tom ntej yuav kov yeej qhov kev txwv no.Cov kev tshawb fawb yav tom ntej tseem tuaj yeem tshawb xyuas thaum twg thiab vim li cas VL raug xaiv dhau DL, suav nrog VL ntau npaum li cas rau cov tshuaj loog siv.

Lwm qhov kev txwv yog tias cov ntaub ntawv tsis muaj cov ntaub ntawv hais txog qee yam ntawm cov txheej txheem intubation nws tus kheej, xws li tus naj npawb ntawm kev sim, lub sij hawm intubation, lossis thawj qhov kev sim ua tiav, uas tuaj yeem cuam tshuam tus neeg mob cov txiaj ntsig.Ib qho kev sim siv ICD-10 cov lej kuaj mob txhawm rau txheeb xyuas cov nqaij mos thiab cov hniav puas thiab cov kab mob nyuaj tau pom muaj qhov tshwm sim tsawg heev ntawm cov ntaub ntawv qhia, uas tej zaum yuav yog vim tsis tiav kev ntes thiab coding (cov ntaub ntawv tsis qhia).Cov ntaub ntawv tsis suav nrog cov neeg mob muaj feem cuam tshuam rau kev nyuaj tracheal intubation xws li qib ntawm qhov ncauj qhib, chav kawm Mallampati, thyromental nrug thiab lub caj dab txav, uas tuaj yeem cuam tshuam rau tus kws kho mob txoj kev npaj intubation thiab cuam tshuam rau cov neeg mob.Cov ntaub ntawv tswj hwm tseem tsis suav nrog cov ntaub ntawv kho mob tus neeg mob xws li ASA kev faib tawm, ua kev ntsuam xyuas ntawm tus neeg mob cov yam ntxwv kho mob tawm ntawm qhov kev ntsuas tam sim no.Thaum kawg, kev ntsuam xyuas ntawm qhov cuam tshuam ntev ntawm cov txheej txheem intubation yog dhau ntawm qhov kev tshawb fawb no.Kev cuam tshuam ntawm VL piv rau DL ntawm kev siv kev noj qab haus huv rau cov neeg mob mus sij hawm ntev lossis kev ua neej zoo, uas cuam tshuam los ntawm lub hlwb puas lossis qhov tshwm sim ntawm aspiration pneumonia los ntawm qhov nyuaj intubation, yog tsim nyog rau kev tshawb nrhiav yav tom ntej.

Xaus

Hauv kev xaus, qhov kev tshuaj ntsuam no qhia tias tej zaum yuav muaj kev txhim kho hauv kev noj qab haus huv cov txiaj ntsig siv VL piv nrog DL hla ntau pawg MDC.Txawm hais tias peb tsis tuaj yeem kos cov lus xaus kom txog rau thaum cov kev tshawb fawb yav tom ntej tiav, cov txiaj ntsig tau qhia tias VL yuav zoo dua rau DL rau cov txheej txheem phais xaiv hauv qhov chaw kho mob.Qhov kev tshuaj ntsuam no tseem qhia txog qhov yuav tsum tau muaj cov ntaub ntawv tsim nyog ntawm cov txheej txheem laryngoscopy, txij li kwv yees li 10% ntawm cov xwm txheej tau teev tseg hauv cov ntaub ntawv them nqi seb VL lossis DL tau siv, thiab tsawg dua 0.15% tau teev tseg thaum siv DL.Peb pom zoo kom cov kws kho mob thiab EMR cov tshuab ua kom lawv cov kev siv zog los sau cov ntaub ntawv laryngoscopy, suav nrog cov txheej txheem, tus naj npawb ntawm kev sim intubation thiab ua tiav-ua tsis tiav nrog thawj zaug intubation sim txhawm rau pab txhawb kev tshawb fawb yav tom ntej piv rau cov txheej txheem laryngoscopy.