AMulticenter,RandomizedTrialofRampedPositionversusSniffingPositionduringEndotrachealIntubationofCriticallyIllAdults.

        危重病人氣管插管傾斜位比較嗅物位的多中心隨機試驗。

        BACKGROUND 背景

        Hypoxemia is the most common complication duringendotrachealintubationofcriticallyilladults.Intubationin therampedpositionhas been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration ofintubation, but has never been studied outside of the operating room.

        低氧血症是危重症成人患者氣管內插管最常見的並發症。傾斜位插管被認為可以通過增加功能殘氣量和降低插管時限來預防低氧血症，但這種假設從未在手術室外研究過。

        METHODS 方法

        Multicenter,randomizedtrialcomparingrampedposition(head of the bed elevated to 25 degrees) tosniffingposition(torso supine, neck flexed, head extended) among 260adultsundergoingendotrachealintubationby Pulmonary and Critical Care Medicine fellows in four intensive care units between July 22, 2015 and July 19, 2016. The primary outcome was lowest arterial oxygen saturation between induction and two minutes afterintubation. Secondary outcomes included Cormack-Lehane grade of glottic view, difficulty ofintubation, and number of laryngoscopy attempts.

        多中心、隨機試驗，在 2015 年 7 月 22 日至 2016 年 7 月 19 日的四個重症監護病房中，肺部和危重病醫學的研究員對260 位成年患者進行氣管插管操作，並比較傾斜位(床頭升高25度)和嗅物位(軀幹仰臥位，頸部彎曲，頭伸展)的成果。主要結果是插管和插管後的2分鍾之間的最低動脈血氧飽和度。次要結局包括喉鏡暴露視野的Cormack-Lehane分級、困難氣管插管和喉鏡嚐試插管的次數。

        RESULTS 結果

        The median lowest arterial oxygen saturation was 93% [IQR 84-99%] withrampedpositionversus92% [IQR 79-98%] withsniffingposition(P = .27).Rampedpositionappeared to increase the incidence of grade III or IV view (25.4% vs 11.5%, P = .01), increase the incidence of difficultintubation(12.3% vs 4.6%, P = .04), and decrease the rate ofintubationon the first attempt (76.2% vs 85.4%, P = .02).

        平均最低動脈血氧飽和度傾斜位為93%[IQR 84-99%] 、嗅物位為92%[IQR 79-98%] 。傾斜位能增加III級或IV分級喉鏡暴露視野(25.4% 對比 11.5%, P = .01)，增加困難插管發生率(12.3% 對比 4.6%, P = .04)，降低第一次嚐試插管的成功率(76.2% 對比 85.4%, P = .02)。

        CONCLUSIONS 結論

        In thismulticentertrial,rampedpositiondid not improve oxygenation duringendotrachealintubationofcriticallyilladultscompared tosniffingposition.Rampedpositionmay worsen glottic view and increase the number of laryngoscopy attempts required for successfulintubation.

        在這個多中心試驗中，對比嗅物位，傾斜位並未改善重症患者插管期間的氧合。傾斜位可能使喉鏡暴露視野更差，而且增加插管成功的喉鏡嚐試次數。