醫學生使用Trachway及Glidescope 在模型假人執行氣管插管之比較

研究目的：Trachway 影像式插管通條是一種新的插管工具，關於這種新插管工具的資訊非常有限，尤其是由初學者操作的情形，因此我們設計一個由35位實習醫學生參與的模型假人插管研究來比較Trachway 及 Glidescope 的插管結果。研究方法：本研究經由中山醫學大學倫理委員會審查核准通過 ( 案號: CS-11226 )，且得到參與者的同意書。本研究採用一個隨機交叉式的研究設計 ( randomized crossover design ) ，參與者會在正常及模擬的困難插管兩種情境下進行假人模型的氣管插管。在口頭教導、示範及演練後，每位參與者會使用被隨機分配到的第一種插管工具，在一般的模型假人操作正常模式之下總計十次的氣管插管，之後再使用另一種插管工具在相同模式之下操作另外十次的氣管插管，每位參與者工具的使用順序是使用抽籤方式隨機決定，插管時間的定義為 : 從插管工具通過模型的門牙為開始，從螢幕上看到氣管內管通過聲門開始移除通條為結束；我們研究的變項包括：插管時間、Cormack＆Lehane 分級、插管成功率、食道或氣管插管、可聽見的牙齒壓迫聲響、利用他人幫忙輔助的優化技巧，這些變項都會被記錄。在正常模式的所有插管完成後，由參與者評定自己感覺每項插管工具使用之難易程度 ( 使用Likert 量表，由 1 (最容易) 到 5 (最困難) )。模擬的困難插管也是以相同的模式進行。研究結果：在成功率方面，兩種工具在兩種模式下都沒有達到統計學上的顯著水準；和Glidescope組相比，Trachway 組有比較短的插管時間(在正常模式14.3±5.2 vs. 19.7±9.7 秒, p<0.001; 模擬的困難插管模式13.9±5.7 vs. 15.9±7.0秒, p<0.001)、有較好的Cormack＆Lehane 分級、較少的牙齒傷害、較少使用優化技巧、使用者評定較容易使用；但是，Trachway 組有比較多的食道插管的情況。這些結果在兩種模式下都是相似的。結論： 在沒有經驗的醫學生操作之下，Trachway組比Glidescope組有較好的插管結果，並且使用者評定Trachway較容易使用。然而，運用在臨床上是否會有相同的結果，可能需要未來更多的研究來加以證實。

Trachway® Videolight Intubating Stylet is a new airway device. Information about Trachway® use by novice laryngoscopists is limited. We compared the outcome of tracheal intubation using Trachway® and Glidescope® performed by 35 medical interns.MethodsThis study was approved by the Institutional Review Board of Chung Shan Medical University Hospital and written informed consent was obtained from each participants. A randomized crossover design was utilized in this study. The participants performed tracheal intubations in two scenarios: normal and simulated difficult airways. Following oral instructions and a demonstration, each participant performed 10 tracheal intubations with the first device and then another 10 tracheal intubations with the other device in a normal scenario. The order of device used was randomized. Intubation time was defined as the time from insertion of the device into the mouth till the tracheal tube passed through the vocal cord as seen on the monitor. Variables studied included the followings: intubation time, the Cormack Lehane grade, successful rates, esophageal or tracheal intubation, audible dental clicking sound (indicating excessive force by the blade on the teeth) and utilization of optimization maneuvers. Thereafter, the interns rated the ease or difficulty of intubation using the Likert scale from 1 (easiest) to 5 (most difficult). Tracheal intubations in a simulated difficult airway scenario were performed in the same fashion.Results and discussionThere was no significant difference in the success rate in both scenarios. Compared to the Glidescope group, the Trachway group had a shorter intubation time (14.3±5.2 vs. 19.7±9.7 seconds in a normal scenario, p<0.001; 13.9±5.7 vs. 15.9±7.0 seconds in a simulated difficult airway scenario, p<0.001), a better laryngoscopic view, less dental trauma, fewer optimization maneuvers and was ranked higher for ease of use. However, the Trachway group had more esophageal intubations. These findings were similar in both normal and simulated difficult airways.We found that participants spent less time to complete intubation in the difficult scenario than in the normal scenario, especially in the Glidescope group. We thought it might be a carryover effect resulting from the learning sequence and that more practice with Glidescope was probably needed than Trachway to achieve a similar intubation performance. Repeat measure ANOVA revealed different intubation device and the number of intubation attempts both had a significant effect on intubation time. The interaction between intubation device and number of intubation attempts did not reach statistical significance.In conclusion, the Trachway group had better intubation results than the Glidescope group in the novice operators, and Trachway was rated as easier to intubate, especially in difficult airways.