Uhlalutyo lwezoqoqosho lokusetyenziswa kwe-laryngoscopy yevidiyo ngokubhekiselele kwi-laryngoscopy ngokuthe ngqo kwindawo yotyando

IINDABA1

Abstract

Injongo: Xa kuthelekiswa ne-laryngoscopy ethe ngqo (DL), ividiyo ye-laryngoscopy (VL) inikezela ngeenzuzo zeklinikhi kwindlela yesiqhelo kunye nobunzima bomoya.Inzuzo yezoqoqosho yezempilo ye-VL ngokuchasene ne-DL ye-tracheal intubation yesiqhelo ayisaziwa.Izinto eziphathekayo kunye neendlela: Olu hlalutyo luthelekisa iziphumo zoqoqosho lwezempilo ze-VL kunye ne-DL, kubandakanywa iindleko ezipheleleyo zokulala, ubude besibhedlele (LOS), ukwamkelwa kweyunithi yokunakekelwa kwe-postoperative (ICU) kunye nezehlo zeengxaki ezinxulumene nenkqubo.Iziphumo: Izigulane ezine-VL ziye zanciphisa iindleko zezigulana (US$1144–5891 kuzo zonke iindidi ezisibhozo zokuxilonga [MDC]);> Ukucuthwa kwe-LOS yosuku olu-1 kwiiMDC ezintlanu;ukunciphisa amathuba okungeniswa kwe-ICU emva kokusebenza (0.04-0.68) kunye nokunciphisa iingxaki zokuphefumula kwii-MDC ezintathu (0.43-0.90).Isiphelo: I-laryngoscopy yevidiyo inokunciphisa iindleko zizonke, ukunciphisa i-LOS kunye nokunciphisa amathuba okungeniswa kwe-ICU emva kokusebenza.

Lay abstract

Kolu phononongo, siqhathanise umahluko kwiindleko zesibhedlele, ubude besibhedlele, iingxaki emva kotyando kunye nokwamkelwa kweyunithi yokhathalelo lwasemva kotyando (ICU) phakathi kwamaqela amabini ezigulane.Omabini amaqela ezigulane angeniswe esibhedlele ngenkqubo yokuhlinzwa kwaye afumana i-anesthesia jikelele ubuncinane ubuncinane kwi-1 h.Ngaphambi kokwenza utyando, ingcali yokuthomalalisa iintlungu ifaka umbhobho kumzila womoya womguli ukuze akhuphe umoya womguli.I-anesthesiologist inokusebenzisa iindidi ezahlukeneyo ze-laryngoscope ukuncedisa ngokufaka ityhubhu.Ukukhethwa kohlobo lwe-laryngoscope lusekelwe kwizinto ezininzi ezifana nokufumaneka kwesixhobo, amava kagqirha, ukhetho kunye neemeko zonyango kunye nomzimba wesigulane.Olu phononongo lujolise kwiindidi ezimbini ezahlukeneyo zelaryngoscopes: ividiyo yelaryngoscope kunye nelaryngoscope ethe ngqo.Izigulane ezifumene i-laryngoscope yevidiyo okanye i-laryngoscope ethe ngqo zahlulwa zibe ngamaqela ahlukeneyo.Siye saqinisekisa ukuba la maqela mabini ezigulane afaniswa ngokweminyaka efanayo, isini kunye neemeko zezifo, ahlala kwiintlobo ezifanayo zezibhedlele kwaye zineenkqubo ezifanayo.Xa kuthelekiswa neqela le-laryngoscope elithe ngqo, iqela levidiyo le-laryngoscope lineendleko eziphantsi zesibhedlele (ezincitshiswe yi-US $ 1144-5891), ubuncinane ubuncinane beentsuku ezi-1 zokuhlala esibhedlele, ukunciphisa amaxabiso okungeniswa kwe-ICU kunye neengxaki ezimbalwa.Olu phononongo lubonisa ukuba i-laryngoscopy yevidiyo ibonelela ngeenzuzo ngaphezu kwe-laryngoscopy ethe ngqo kwiinkqubo zotyando ezikhethiweyo.

b086a422

I-Tweetable abstract

I-laryngoscopy yevidiyo inxulunyaniswa neendleko zesibhedlele ezincitshisiweyo, ubude obufutshane bokuhlala, amaxabiso aphantsi okungeniswa kwe-ICU kunye neengxaki ezimbalwa xa kuthelekiswa ne-laryngoscopy ngqo.#videolaryngoscopy #healtheconomics.

I-Laryngoscopy kunye nokubekwa kwetyhubhu yoqhoqhoqho yinkqubo eqhelekileyo eneengxaki ezinqabileyo kodwa ezinokuba qatha.Ngo-2010, kuqikelelwa ukuba iityhubhu ze-tracheal zazisetyenziswa ngexesha lotyando lwezigidi ezili-15 e-USA.1].I-intubation enzima kwaye ayiphumelelanga iyenzeka ngaphantsi kwe-6% kunye ne-0.3% yamatyala, ngokulandelanayo, kwaye kunokwenzeka ukuba kwenzeke kwimeko engxamisekileyo okanye kwindawo yokhathalelo olunzima kunemeko yegumbi lokusebenza [2,3].Nangona izehlo zabo zisezantsi kakhulu, xa iingxaki ezinxulumene ne-intubation enzima kwaye engaphumeleliyo zenzeka, zinokungaguquleki kwaye zibulale [4].Kuphononongo lwase-US, i-2.3% yokufa okunxulumene ne-anesthesia ngenxa yokungaphumeleli okanye intubation enzima [5].Ngako oko, ukuchonga ukuphuculwa kokunyusa impumelelo ye-tracheal intubation kunye nokhuseleko yinto ephambili kwizibhedlele.

Ukuqaliswa kwevidiyo ye-laryngoscopy (VL) kwi-kliniki yokusebenza kubonisa ukuqhubela phambili okubalulekileyo.Ngokungafaniyo ne-laryngoscopy ethe ngqo (DL) exhomekeke kumgca othe ngqo wendlela yokubona ekuvulekeni kweglottic, i-VL isebenzisa indlela engathanga ngqo, ithumela imifanekiso ukusuka kwincam yencakuba ukubonwa okuphuculweyo kokuvuleka kweglottic.Izifundo ezininzi zibonise ukuba i-VL iyanciphisa izehlo ze-intubation enzima kwaye iphezulu kwizigulane ezineendlela zomoya ezinzima ezixelwe kwangaphambili.3].Ukusetyenziswa kwe-VL kuya kunconywa ngakumbi kwizikhokelo zendlela yomoya njengeyona ndlela iphambili yokufaka intubation kwaye njengendlela yokuhlangula xa i-DL ingaphumeleli [6,7].Uninzi lweziganeko ezinzima ze-intubation zingalindelekanga ngaphandle kovavanyo olwaneleyo [4,8,9].Ngoko ke, ixabiso elinokubakho lokusebenzisa i-VL njengendlela yomgca wokuqala yingxoxo enentsingiselo [10–14].

Olu phononongo lweqela elibuyelayo lwenziwa ukuhlalutya iziphumo zeklinikhi kunye nezoqoqosho ze-VL ngokuchasene ne-DL kwiqela lezigulane kwindawo yokusebenza.Uphononongo lusebenzise iDatabase yeNkulumbuso yezeMpilo, emele malunga ne-25% yokwamkelwa kwezigulane zase-US ngonyaka ngamnye.Ibandakanya izigulane ezininzi, iintlobo zeenkqubo zotyando kunye neendawo zesibhedlele, okwenza kube ngumthombo ocebileyo wokuthelekisa iziphumo zeenkqubo ezahlukeneyo ezifana ne-DL kunye ne-VL.Iziphumo zinokuba luncedo koogqirha abacinga ukuba ingaba i-VL kufuneka ithathelwe ingqalelo ngaphezu kwe-DL njengeyona ndlela iphambili ye-tracheal intubation.

Izixhobo kunye neendlela

Uyilo lofundo

Senze uphando lwe-retrospective observational cohort sisebenzisa iminyaka eyi-3 yedatha (2016-2018) evela kwi-Premier Healthcare Database.I-Database yeNkulumbuso yezeMpilo ithathwa njengento ekhululekileyo kwiBhodi yokuHlola iBhodi njengoko kuchazwe kwiSihlokwana se-45 yeKhowudi ye-Federal Regulations, iSigaba 46 sase-US, ngokukodwa 45 CFR 46.101 (b) (4).Ngokuhambelana ne-Health Insurance Portability and Accountability Act Privacy Rule, idatha eveziweyo evela kwiNkulumbuso ithathwa njengengachazwanga ngokwe-45 CFR 164.506 (d) (2) (ii) (B) ngokusebenzisa 'Ukumiselwa kweNgcali'.

Ukukhetha iqela

Zonke izigulane ezikhulileyo eziye zafumana utyando olukhethiweyo kwindawo yokulala kunye ne-1 h ye-anesthesia jikelele kunye ne-tracheal intubation (enegama elingundoqo elithi 'intubation' kwifayile ye-master master) yabuzwa (n = 72,284,Umfanekiso woku-1).Imfuno ye-1 h ye-anesthesia jikelele yayijoliswe ukuba ingabandakanyi izigulane ezithatha iinkqubo ezincinci zotyando.Iimeko ezingxamisekileyo kunye nezigulana ezikhulelweyo zazingabandakanywanga ngenxa yokuba iindlela zonyango kunye neemeko zesigulana zinokwahluka kakhulu kubantu abakhethiweyo botyando.Izigulane zahlulwe kwiindidi ze-25 eziphambili zokuxilonga (MDC) ngokusekelwe kwiqela labo elihlobene nokuxilongwa (DRG).Iqela lokugqibela libandakanya izigulane zabantu abadala kumaqela alishumi aphezulu e-MDC, athatha i-86.2% yezigulane zotyando ezikhethiweyo (n = 62,297 / 72,284,Umfanekiso woku-1).

 

Umzobo 1. Itshati ejikelezayo yokubandakanywa kwesigulane.Umzobo obonisa imigaqo esetyenziswayo ukufika kwiqela lokugqibela lesigulane.Ukulungelelanisa ukungalingani kwesampulu phakathi kwe-DL kunye namaqela e-VL, izigulane zikhethwe ngokungenamkhethe kwi-3: umlinganiselo we-1 we-DL: i-VL kwi-MDC nganye, ngaphandle kweZifo kunye ne-Disorders ye-Ear, Impumlo, uMlomo kunye neqela le-Throat, apho i-2: 1 DL: i-VL ratio isetyenzisiweyo ngenxa yokuba kwakukho izigulane ezimbalwa kwiqela le-DL ukukhetha kwi-3: umlinganiselo we-1.

DL: Laryngoscopy ngqo;I-MDC: Udidi lwezifo ezingundoqo;VL: I-laryngoscopy yevidiyo.

Ngokusekelwe kuhlobo lwelaryngoscope esetyenziselwa intubation, i-cohort yahlulwa ibe ngamaqela e-DL kunye ne-VL.Ukukhangela kwegama elingundoqo kwifayile ye-charge master yasetyenziselwa ukuchonga i-laryngoscope (DL vs VL).Amagama angundoqo aquka indibaniselwano yegama lomenzi, igama lencakuba, ubungakanani, uhlobo kunye namabinzana athi 'ividiyo ye-laryngoscopy' okanye 'i-laryngoscopy ethe ngqo' kunye nezishunqulelo zazo (ITheyibhile eyoNgezelelweyo 1).Ingcali yokubuyisela imbuyekezo ihlolisise uluhlu lwamagama angundoqo kwaye yaqinisekisa ukuchaneka kokuhlelwa ngokweendidi.Izigulane ezingenalo irekhodi lohlobo lwe-laryngoscopy esetyenzisiweyo zabelwa kwiqela le-DL.Oku kwenziwa ngenxa yokuba i-DL yayisoloko ihlanganiswa kwingxelo ye-anesthesia jikelele kwaye ngoko yayingaxelwanga.Kwakukho izigulane ezininzi eziphantsi kwe-DL xa kuthelekiswa nezo zifumana i-VL kwiqela lethu (n = 55,320 vs 6799).Ngoko ke, izigulane ezifumana i-DL zikhethwe ngokungenamkhethe ngaphakathi kweqela ngalinye leMDC kwinqanaba le-3: 1 (DL: VL), ukunciphisa ukungalingani kwesampulu phakathi kwamaqela ngelixa ugcina isigulane kunye neempawu zesibhedlele zeqela lokuqala le-DL [15,16].Kwi-Ear, Nose, Mouth, and Throat disease MDC, umlinganiselo wawuyi-2: 1 DL: VL kuba iqela le-DL lalincinci kakhulu ukuvelisa umlinganiselo we-3: 1.

Uhlalutyo lobuthathaka

Ukuqinisekisa ukuba ulwahlulo phakathi kwamaqela alukho ngenxa yokungalungi kwezigulane eziye zafumana i-DL, uhlalutyo lokuqonda lwenziwa.Kolu hlalutyo, ukukhawulelwa kwe-1 h yexesha lotyando kususwe ukubandakanya iimeko ezininzi ze-DL.Indlela yokulinganisa i-propensity yasetyenziselwa ukulinganisa iimpawu zekliniki kunye nesibhedlele phakathi kwamaqela e-DL kunye ne-VL kwinqanaba ngalinye leMDC.Esinye isigulane kwiqela le-DL sasihlala esibhedlele ixesha elide (iintsuku ze-472) kwaye sasingabandakanywa kuhlalutyo.Esi sigulana sinesimo se-neurologic kunye ne-epilepsy (ikhowudi yokuqala ye-ICD_10 yokuxilongwa: G40.909), kwaye ngosuku lwesibhedlele #123 yafumana i-tracheotomy kunye nokubekwa kwesixhobo se-tracheostomy (ICD_10 ikhowudi yenkqubo yokuhlinzwa: 0B110F4).

Amanyathelo esiphumo

Iziphumo eziphambili zibandakanya iindleko zizonke zezigulana, ubude bexesha lokuhlala esibhedlele (i-LOS), izinga lokungeniswa kwiyunithi yokhathalelo lwasemva kotyando (ICU) kunye neengxaki ezifanelekileyo zasemva kotyando.Ukwamkelwa kwe-ICU emva kokuhlinzwa kwachazwa njengezigulane ezingeniswe kwi-ICU ngomhla okanye emva komhla wotyando.Iingxaki ze-postoperative zichongiwe kusetyenziswa iikhowudi ze-ICD-10 zokusuleleka kwi-pulmonary (J15, J18), iingxaki ze-cardiovascular (I20, I21, I24, I46), iingxaki zokuphefumula (J98.1, J95.89) kunye nezinye iingxaki zonyango lonyango (T88) ) (ITheyibhile eyoNgezelelweyo yesi-2).

Uhlalutyo lwamanani

Uhlalutyo lwe-univariate lwalusetyenziselwa ukuthelekisa i-demographics yesigulane esisisiseko, iimpawu zekliniki kunye neempawu zesibhedlele.Uvavanyo lwe-Chi-square okanye uvavanyo oluchanekileyo lukaFisher lwalusetyenziselwa ukuguquguquka kwecategorical kunye novavanyo lweWilcoxon kwizinto eziguquguqukayo eziqhubekayo.Ii-p-values ​​zinemisila emibini ngokubaluleka kweenkcukacha-manani ezibekwe kwi-p <0.05.

Umahluko weendleko zesigulana esilungisiweyo uqikelelwe kusetyenziswa imodeli yoqikelelo oluqhelekileyo (GEE) kunye nokuhanjiswa kwe-gamma.Ubude obulungisiweyo bomahluko wokuhlala buqikelelwe kusetyenziswa imodeli yeGEE kunye nokuhanjiswa kwePoisson.Ukuhlehliswa kwezinto ezininzi zenziwa ukuqikelela umahluko kwireyithi ye-ICU yasemva kokusebenza kunye nezinga lobunzima.Kuba amazinga obunzima enqabile, indlela ka-Firth yokufumana isohlwayo iye yasetyenziswa ukunciphisa iisampulu ezincinci kuqikelelo olunokuba kho kwiimodeli zokubuyela umva.Zonke iimodeli ezilawulwa kwiimpawu zesiseko zesigulane, kubandakanywa iminyaka yesigulane, isini, uhlanga, isimo somtshato, i-Charlson comorbidity index kunye ne-inshurensi ephambili, kunye neempawu zesibhedlele, kubandakanywa ukufundisa isimo sesibhedlele, ubungakanani bebhedi, imimandla yesibhedlele kunye nendawo.Lonke uhlalutyo lwamanani lwenziwa kusetyenziswa i-SAS Version 9.4 (SAS Institute Inc., NC, USA).

Iziphumo

Iimpawu zesigulana kunye nesibhedlele

Iyonke izigulane ezingama-62,297 zadibana neendlela zokukhetha uphononongo.Emva kwe-1: 3 (VL: DL) ukhetho olukhethiweyo kwiqela le-DL (1: 2 VL: DL yeZifo zeNdlebe, iimpumlo, uMlomo kunye neqela leMDC ye-Throat), iqela lokugqibela laliquka izigulane ze-6799 ezifumana i-VL kunye ne-20,867 izigulane ezifumana i-DL (Umfanekiso woku-1).

I-demographics yesigulane kunye neempawu zeklinikhi, kunye neempawu zesibhedlele zezigulane kwiqela le-VL kunye ne-DL, ziboniswa kwiUluhlu loku-1.Xa kuthelekiswa neqela le-DL, izigulane ezifumene i-VL zazincinci (umyinge weminyaka eyi-60.9 iminyaka vs 61.5 iminyaka, p = 0.0007), kunokwenzeka ukuba yindoda (52.5% [n = 3666 / 6977] vs 45.1% [n = 9412 / 20,867], p <0.0001) kunye neCaucasian (80.4% [n = 5609/6977] vs 76.2% [n = 15,902 / 20,867], p <0.0001).Xa kuthelekiswa neqela le-DL, izigulane ezikwiqela le-VL zazinokuthi zingeniswe kwizibhedlele ezazisemaphandleni kwaye zingamaziko okufundisa (18.9% [n = 1321/6977] vs 11.8% [n = 2463/20,867], p <0.0001 kunye ne-42.6% [n = 2972/6977] vs 28.9% [n = 6038/20,867], p <0.0001, ngokulandelanayo), kwaye ezo zazikummandla weMidwest kunye neNtshona (26.1% [n = 1820/6977] vs 5.3% [n = 1101/20,867], p <0.0001 kunye ne-24.8% [n = 1731/6977] vs 7.2% [n = 1506/20,867], p <0.0001, ngokulandelanayo).Ixesha eliqhelekileyo le-anesthesia lalide kwiqela le-VL (227 min vs 218 min, p <0.0001).Ukuhanjiswa kwezigulane kuwo wonke amaqela e-MDC kwakufana phakathi kwe-VL kunye namaqela e-DL (p = 0.6122).

Uluhlu loku-1.Iimpawu zesigulana kunye nesibhedlele.
Iimpawu zabantu abaguli Ilaryngoscopy yevidiyo (n = 6977)
Ithetha (SD)
Ilaryngoscopy ethe ngqo (n = 20,867)
Ithetha (SD)
p-ixabiso
Ubudala (iminyaka) 60.9 (12.9) 61.5 (13.7) 0.0007
n (%) n (%)
Isini <0.0001
– Owasetyhini 3311 (47.5%) 11,455 (54.9%)
– Indoda 3666 (52.5%) 9412 (45.1%)
Ubume obuxela ukuba utshatile okanye awutshatanga <0.0001
Utshatile 4193 (60.1%) 12,633 (60.5%)
– Ungatshatanga 2537 (36.4%) 7918 (37.9%)
– Okunye 247 (3.5%) 316 (1.5%)
Ugqatso <0.0001
- eCaucasian 5609 (80.4%) 15,902 (76.2%)
– Afrika–Amerika 688 (9.9%) 3502 (16.8%)
– Okunye 621 (8.9%) 1356 (6.5%)
– Akwaziwa 59 (0.8%) 107 (0.5%)
Uhlobo lwe-inshurensi <0.0001
– Urhulumente 4135 (59.3%) 11,566 (55.4%)
– HMO/yorhwebo 2403 (34.4%) 7094 (34.0%)
– Okunye 371 (5.3%) 1955 (9.4%)
– I-inshurensi yobuqu 68 (1.0%) 252 (1.2%)
Iimpawu zeklinikhi yesigulane Ithetha (SD) Ithetha (SD)
Ixesha elipheleleyo le-anesthesia, min 227 (130.9) 218 (188.5) <0.0001
n (%) n (%)
Charlson comorbidity index 0.044
– 0 2795 (40.1%) 8653 (41.5%)
– 1–2 2771 (39.7%) 7936 (38.0%)
– 3–4 850 (12.2%) 2497 (12.0%)
– 5 nangaphezulu 561 (8.0%) 1781 (8.5%)
Udidi oluphambili lokuxilonga (MDC), izifo kunye nokuphazamiseka koku: 0.612
– Indlebe, impumlo, umlomo nomqala 68 (1.0%) 137 (0.7%)
– Inkqubo yokuphefumla 212 (3.0%) 636 (3.0%)
– Inkqubo yokujikeleza 656 (9.4%) 1968 (9.4%)
– Inkqubo yokwetyisa 825 (11.8%) 2475 (11.9%)
- Inkqubo yeHepatobiliary kunye ne-pancreas 122 (1.7%) 367 (1.8%)
- Inkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo 3725 (53.4%) 11,176 (53.6%)
-I-Endocrine, isondlo kunye nenkqubo ye-metabolic 582 (8.3%) 1747 (8.4%)
– Izintso kunye nomchamo 265 (3.8%) 795 (3.8%)
– Inkqubo yokuzala yamadoda 151 (2.2%) 453 (2.2%)
– Inkqubo yokuzala yabasetyhini 371 (5.3%) 1113 (5.3%)
Iimpawu zesibhedlele n (%) n (%)
Indawo yesibhedlele <0.0001
– Emaphandleni 1321 (18.9%) 2463 (11.8%)
– Edolophini 5656 (81.1%) 18,404 (88.2%)
Isibhedlele sokufundisa <0.0001
- Hayi 4005 (57.4%) 14,829 (71.1%)
- Ewe 2972 (42.6%) 6038 (28.9%)
Ubungakanani bebhedi <0.0001
– 000–299 2929 (42.0%) 6235 (29.9%)
– 300–499 2112 (30.3%) 10,286 (49.3%)
– 500+ 1936 (27.7%) 4346 (20.8%)
Ummandla wesibhedlele <0.0001
– Midwest 1820 (26.1%) 1101 (5.3%)
– kuMntla-mpuma 487 (7.0%) 1097 (5.3%)
- Mazantsi 2939 (42.1%) 17,163 (82.2%)
– eNtshona 1731 (24.8%) 1506 (7.2%)

Amaxabiso axelwa njengentsingiselo (SD) okanye inani (umlinganiselo).

Uvavanyo lwe-Chi-square lusetyenziselwe ukuguquguquka kwecategorical kunye novavanyo lwe-t yoMfundi yeenguqu eziqhubekayo.

DL: Ilaryngoscope ethe ngqo;I-MDC: Udidi oluphambili loxilongo;SD: Ukutenxa emgangathweni;VL: Ividiyo yelaryngoscope.

Iyonke indleko yezigulana

Emva kokulawula izigulane kunye neempawu zeklinikhi kunye nezibhedlele, xa kuthelekiswa neqela le-DL, iqela le-VL lalinomlinganiselo ophantsi kakhulu weendleko zokulala kwizigulane ezisibhozo kwamaqela alishumi e-MDC.Umfanekiso wesi-2A).Umahluko weendleko phakathi kwamaqela e-VL kunye ne-DL ukusuka kwi-$ 1144 ukuya kwi-$ 5891 kuwo wonke amaqela asibhozo e-MDC.Amaqela e-MDC anelona xabiso liphantsi kunye nelona liphezulu lokonga kwi-avareji yeendleko zezigulane zizonke yayiziZifo kunye neZiphazamiso zeqela leNdlela yokuZala yaMadoda ($ 13,930 vs $15,074, p <0.032), kunye neZifo kunye neZifo zeNdlebe, impumlo, uMlomo kunye neqela lomqala ($ 13,485 vs $ 19,376, p <0.0001), ngokulandelanayo.Akukho mahluko ubonwe kumndilili weendleko ezipheleleyo zokulaliswa phakathi kweVL kunye namaqela e-DL kwiZifo kunye neZifo kunye neZifo zeNkqubo yeCyculatory System iqela leMDC ($45,594 vs $44,155, p = 0.1758).


Umzobo 2. Ixabiso lilonke lesigulana esilaliswayo. (A) Uhlengahlengiso lomndilili weendleko zezigulane ezilalisiweyo kwizigulane ezifumana i-DL kunye ne-VL kwicandelo ngalinye lesifo esikhulu (MDC), kusetyenziswa imodeli ye-GEE kunye nokuhanjiswa kwe-gamma ukulungelelanisa ukungafani kwisigulane esisisiseko kunye neempawu zesibhedlele.I-avareji yeendleko zezigulane ezilaliswayo kunye ne-95% CI zibonisiwe.(B) Kujongwe (engalungiswanga) umndilili weendleko zezigulane ezilaliswayo kwizigulane ezine-DL ne-VL kwiqela ngalinye le-MDC.I-avareji yeendleko kunye nokutenxa okusemgangathweni kuyaboniswa.Akukho phawu, alubalulekanga (p ≥ 0.05).I-VL (imivalo ezaliswe ngokupheleleyo);DL (imivalo evulekileyo).

*p <0.05;**p <0.01;***p <0.001.

DL: Laryngoscopy ngqo;I-MDC: Udidi lwezifo ezingundoqo;VL: I-laryngoscopy yevidiyo.

Kuhlalutyo olungalungiswanga, xa kuthelekiswa neqela le-DL, iqela le-VL lalinomlinganiselo ophantsi kakhulu weendleko zezigulana kumaqela amathathu kwalishumi e-MDC (Umfanekiso wesi-2B).Ezi zizifo kunye nokuphazamiseka kwenkqubo yokugaya (i-$ 21,021 vs $ 24,121, p = 0.0007), izifo kunye nokuphazamiseka kwenkqubo yokuphefumula (i-$ 25,848 vs $ 31,979, p = 0.0005), kunye nezifo kunye nokuphazamiseka kwendlebe, impumlo, umlomo. kunye nomqala ($ 15,886 vs $ 21,060, p = 0.017) amaqela eMDC.Umndilili ongalungiswanga weendleko zezigulane ezilaliswayo ubuphezulu kwiqela le-VL xa kuthelekiswa neqela le-DL kumaqela amabini e-MDC;izifo kunye nokuphazamiseka kwenkqubo yokuzala yamadoda ($ 13,891 vs $ 11,970, p = 0.0019) kunye nezifo kunye nokuphazamiseka kwenkqubo yokuzala yabasetyhini ($ 14,367 vs $ 12,041, p = 0.003).

Ubude bokuhlala

Emva kokulawula izigulane kunye neempawu zekliniki kunye nezibhedlele, xa kuthelekiswa neqela le-DL, iqela le-VL lalinomlinganiselo omfutshane ohlengahlengisiweyo wesibhedlele i-LOS kuwo wonke amaqela alithoba alishumi e-MDC.Umndilili we-LOS umahluko wawubalulekile ngokwezibalo kumaqela asibhozo kwalishumi e-MDC (Umfanekiso wesi-3A).Ukunciphisa umyinge we-LOS kwaba mkhulu kuneentsuku ze-1 kumaqela amahlanu e-MDC, kubandakanywa izifo kunye nokuphazamiseka kwendlebe, impumlo, umlomo kunye nomqala (iintsuku ze-3.2 vs 4.6 iintsuku, p <0.0001), kunye nezifo kunye nokuphazamiseka kwenkqubo yokutya. (Iintsuku eziyi-8.0 vs 9.4 iintsuku, p <0.0001).


Umzobo 3. Ubude obupheleleyo besibhedlele sokuhlala.(A) I-LOS kwiqela ngalinye le-MDC, usebenzisa imodeli ye-GEE kunye nokusabalalisa kwe-Poisson ukulungelelanisa ukungafani kwisigulane esisisiseko kunye neempawu zesibhedlele.Umyinge we-LOS kunye ne-95% CI ibonisiwe.(B) Ukujongwa (okungalungiswanga) ubude besibhedlele kwizigulane ezifumana i-DL kunye ne-VL kwiqela ngalinye le-MDC.Umndilili we-LOS kunye nokutenxa okusemgangathweni kubonisiwe.Akukho phawu, NS (p ≥ 0.05).I-VL (imivalo ezaliswe ngokupheleleyo);DL (imivalo evulekileyo).

*p <0.05;**p <0.01;***p <0.001.

DL: Laryngoscopy ngqo;LOS: Ukuhlala ixesha elide esibhedlele;I-MDC: Udidi lwezifo ezingundoqo;NS: Ayibalulekanga;VL: I-laryngoscopy yevidiyo.

Umyinge ongalungiswanga we-LOS wawumfutshane kakhulu kwiqela le-VL kumaqela amabini e-MDC alishumi, izifo kunye nokuphazamiseka kwenkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo (i-2.8 vs 3.0 iintsuku, p = 0.0011) kunye nezifo kunye nokuphazamiseka kwenkqubo yokutya (6.0 vs. 7.0 iintsuku, p = 0.0004).Akukho mahluko ubalulekileyo ngokweenkcukacha-manani kumndilili ongalungiswanga we-LOS kuwo onke amaqela e-MDC (Umfanekiso wesi-3B).

Ireyithi ye-ICU yasemva kokusebenza

Phakathi kokwamkelwa kwe-ICU emva kokuhlinzwa, i-90.1% (n = 878/975), kunye ne-87.4% (n = 3077/3521) yenzeke ngosuku olu-1 lwenkqubo yotyando kumaqela e-VL kunye ne-DL, ngokulandelelanayo.

Emva kokulawula i-demographics yesigulane kunye neempawu zeklinikhi kunye nezibhedlele, amathuba okungeniswa kwe-ICU emva kokusebenza ayephantsi kakhulu (p <0.05) kwiqela le-VL kuneqela le-DL kuwo onke amaqela alishumi e-MDC.Umlinganiselo ohlengahlengisiweyo wokwamkelwa kwe-ICU emva kokuhlinzwa ukusuka kwi-0.04 ukuya kwi-0.68 (Uluhlu lwesi-2).

Uluhlu lwesi-2.Ukulungelelaniswa komlinganiselo olungelelanisiweyo weyunithi yokhathalelo olunzulu lwasemva kotyando (i-laryngoscopes ngqo njengesalathiso).
Iindidi zezifo eziphambili Odds ratio (95% LCL, 95% UCL)
Indlebe, impumlo, umlomo nomqala 0.166 (0.066, 0418)
Inkqubo yokuphefumla 0.680 (0.475, 0.974)
Inkqubo yokujikeleza 0.573 (0.455, 0.721)
Inkqubo yokwetyisa 0.235 (0.176, 0.315)
Inkqubo yeHepatobiliary kunye ne-pancreas 0.276 (0.139, 0.547)
Inkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo 0.323 (0.258, 0.404)
I-Endocrine, isondlo kunye nenkqubo ye-metabolic 0.503 (0.309, 0.819)
Izintso kunye nomchamo 0.347 (0.212, 0.569)
Inkqubo yokuzala yamadoda 0.152 (0.038, 0.618)
Inkqubo yokuzala yabasetyhini 0.042 (0.016, 0.111)

Amaxabiso axelwa njengomlinganiselo wemiqobo (esezantsi-phezulu umda wokuzithemba).

ICU: Icandelo labagula kakhulu;LCL: Umda wokuzithemba ophantsi;UCL: Umda wokuzithemba okuphezulu.

Umndilili ongalungiswanga wezinga lokwamkelwa e-ICU emva kotyando ubengaphantsi nge-VL kune-DL kumaqela amathandathu kwalishumi e-MDC.Umehluko wezinga lokungeniswa livela kwi-0.8 ukuya kwi-25.5%, kunye nowona mahluko mkhulu obonwa kwizifo kunye nokuphazamiseka kwendlebe, impumlo, umlomo kunye neqela lomqala (VL vs DL, 17.6% [n = 12/68], vs 43.1% [ n = 59/137], p = 0.0003).Akukho mahluko kumyinge wezinga lokwamkelwa e-ICU emva kotyando kumaqela amane eMDC ashiyekileyo (Itheyibhile 3).

Itheyibhile 3.Izinga lokungeniswa kwiyunithi yokhathalelo oluphezulu.
Iindidi zezifo eziphambili Ividiyo yelaryngoscopy (%) Ilaryngoscopy ethe ngqo (%) p-ixabiso
Indlebe, impumlo, umlomo nomqala 12/68 (17.6) 59/137 (43.1) 0.0003
Inkqubo yokuphefumla 100/212 (47.2) 332/636 (52.2) 0.204
Inkqubo yokujikeleza 472/656 (72.0) 1531/1968 (77.8) 0.002
Inkqubo yokwetyisa 92/825 (11.2) 567/2475 (22.9) 0.0001
Inkqubo yeHepatobiliary kunye ne-pancreas 25/122 (20.5) 132/367 (36.0) 0.0015
Inkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo 166/3725 (4.5) 597/11,176 (5.3) 0.034
I-Endocrine, isondlo kunye nenkqubo ye-metabolic 46/582 (7.9) 121/1747 (6.9) 0.429
Izintso kunye nomchamo 44/265 (16.6) 159/795 (20.0) 0.224
Inkqubo yokuzala yamadoda 7/151 (4.6) 23/453 (5.1) 0.829
Inkqubo yokuzala yabasetyhini 11/371 (3.0) 83/1113 (7.5) 0.002

Amaxabiso axelwa njengenani (umyinge).

ICU: Icandelo labagula kakhulu.

Iingxaki

Emva kokulawula i-demographics yesigulane kunye neempawu zeklinikhi kunye nezibhedlele, amathuba okuba neengxaki ze-perioperative ayephantsi nge-VL xa kuthelekiswa ne-DL kumaqela amaninzi e-MDC.Ukuthelekisa izigulane ezifumana i-VL kwizigulane ezifumana i-DL, amathuba okuba nesifo se-pulmonary ayephantsi kumaqela amathathu e-MDC, kubandakanywa izifo kunye nokuphazamiseka kwe: inkqubo yokugaya;inkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo;kunye ne-endocrine, isondlo kunye nenkqubo ye-metabolic (OKANYE: 0.56, OKANYE: 0.49 kunye OKANYE: 0.30; p = 0.03123, p = 0.02996, kunye p = 0.00441, ngokulandelanayo);ukuba ne-cardiovascular complications yayiphantsi kumaqela amathandathu e-MDC, kubandakanywa izifo kunye nokuphazamiseka kwe: inkqubo yokuphefumula;inkqubo yokwetyisa;inkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo;i-endocrine, izifo zesondlo kunye nenkqubo ye-metabolic;umzila wezintso kunye nomchamo;kunye nenkqubo yokuzala yabasetyhini (OKANYE: 0.28, OKANYE: 0.3, OKANYE: 0.21, OKANYE: 0.12, OKANYE: 0.11 kunye OKANYE: 0.12; p = 0.00705, p = 0.00018, p = 0.00375, p0 <0.0 0.2 p0 = = 0.007, ngokulandelanayo);ukuba neengxaki zokuphefumula kwakungaphantsi kumaqela amathathu eMDC, kubandakanywa izifo kunye nokuphazamiseka kwenkqubo yokujikeleza kwegazi;inkqubo ye-hepatobiliary kunye ne-pancreas;kunye ne-endocrine, isondlo kunye nenkqubo ye-metabolic (OKANYE: 0.66, OKANYE: 0.90 kunye OKANYE: 0.43, p = 0.00415, p <0.0001 kunye p = 0.03245, ngokulandelanayo);ukuba nezinye iingxaki zokuhlinzwa / unyango lwezonyango zaziphantsi kwiqela elinye le-MDC, izifo kunye nokuphazamiseka kwenkqubo ye-hepatobiliary kunye ne-pancreas (OKANYE: 0.9, p <0.0001) kunye neqela eliphezulu le-MDC enye, izifo kunye nokuphazamiseka kwenkqubo yokuzala kwabasetyhini (OKANYE: 16.04, p = 0.00141) (Uluhlu lwesi-4).

Uluhlu lwesi-4.Ukulungelelaniswa komlinganiselo weengxaki ezikhethiweyo (i-laryngoscopes ngqo njengereferensi).
Iindidi zezifo eziphambili Usulelo lwemiphunga Ingxaki yentliziyo Ukuxakeka kokuphefumla Enye ingxaki yotyando/yezonyango
Izifo kunye neengxaki ze: Odds ratio (95% LCL, 95% UCL)
Indlebe, impumlo, umlomo nomqala 0.18 (0.03, 1.17) 0.34 (0.06, 1.99) 0.85 (0.81, 4.04) 0.69 (0.12, 4.11)
Inkqubo yokuphefumla 0.83 (0.50, 1.37) 0.28 (0.11, 0.71) 0.89 (0.56, 1.43) 1.30 (0.42, 4.00)
Inkqubo yokujikeleza 1.09 (0.73, 1.62) 1.05 (0.77, 1.42) 0.66 (0.50, 0.88) 0.38 (0.10, 1.40)
Inkqubo yokwetyisa 0.56 (0.33, 0.95) 0.3 (0.16, 0.56) 0.76 (0.53, 1.10) 1.74 (0.60, 5.11)
Inkqubo yeHepatobiliary kunye ne-pancreas 1.02 (1.00, 1.04) 0.55 (0.17, 1.75) 0.9 (0.88, 0.91) 0.9 (0.88, 0.91)
Inkqubo ye-musculoskeletal kunye nezicubu ezidibeneyo 0.49 (0.30, 0.89) 0.21 (0.13, 0.33) 0.92 (0.65, 1.3) 0.61 (0.25, 1.46)
I-Endocrine, isondlo kunye nenkqubo ye-metabolic 0.30 (0.10, 0.89) 0.12 (0.03, 0.50) 0.43 (0.20, 0.93) 0.80 (0.22, 2.97)
Izintso kunye nomchamo 0.62 (0.25, 1.55) 0.11 (0.03, 0.46) 0.75 (0.40, 1.42) 3.06 (0.73, 12.74)
Inkqubo yokuzala yamadoda 0.99 (0.18, 5.6) 0.65 (0.12, 3.36) 1.73 (0.31, 9.55) 0.96 (0.21, 4.34)
Inkqubo yokuzala yabasetyhini 0.47 (0.15, 1.47) 0.12 (0.02, 0.56) 0.79 (0.30, 2.08) 16.04 (2.92, 88.13)

Amaxabiso axelwa njengomlinganiselo wemiqobo (esezantsi-phezulu umda wokuzithemba).

LCL: Umda wokuzithemba ophantsi;UCL: Umda wokuzithemba okuphezulu.

Kwizifo kunye nokuphazamiseka kwenkqubo ye-circulatory yeqela leMDC, izinga elingalungiswanga leengxaki zokuphefumula liphantsi kakhulu kwiqela le-VL xa kuthelekiswa neqela le-DL (10.8% [n = 71/656], vs 15.5% [n = 305/1968 ], p = 0.003).Kwizifo kunye nokuphazamiseka kwenkqubo yokugaya ukutya kweqela leMDC kunye nenkqubo ye-musculoskeletal kunye neqela le-MDC elidibeneyo, izinga elingalungiswanga leengxaki ze-cardiovascular liphantsi kakhulu kwiqela le-VL xa kuthelekiswa neqela le-DL (1.3% [n = 11/825], vs 3.7% [n = 91/2475], p = 0.008; kunye ne-0.6% [n = 27/3725], vs 1.2% [n = 137/11,176], p = 0.003, ngokulandelanayo).Kwakungekho nolunye ulwahlulo olubalulekileyo kumazinga obunzima obungalungiswanga phakathi kweVL kunye namaqela e-DL namanye amaqela eMDC (Uluhlu 5).

Uluhlu 5.Iingxaki ngamacandelo amakhulu ezifo.
Iingxaki Ividiyo yelaryngoscopy (n) Ilaryngoscopy ethe ngqo (n) p-ixabiso
Indlebe, impumlo, umlomo nomqala, n (%) 68 137
– Usulelo lwemiphunga 0 (0.0) 5 (3.7) 0.173
-Ingxaki yentliziyo 0 (0.0) 4 (2.9) 0.304
–Ingxaki yokuphefumla 1 (1.5) 2 (1.5) 1
– Ezinye iingxaki zotyando/zonyango 0 (0.0) 2 (1.5) 1
Inkqubo yokuphefumla, n (%) 212 636
– Usulelo lwemiphunga 25 (11.8) 78 (12.3) 0.856
-Ingxaki yentliziyo 5 (2.4) 38 (6.0) 0.045
–Ingxaki yokuphefumla 28 (13.2) 96 (15.1) 0.501
– Ezinye iingxaki zotyando/zonyango 2 (0.9) 6 (0.9) 1
Inkqubo yokujikeleza, n (%) 656 1968
– Usulelo lwemiphunga 41 (6.3) 97 (4.9) 0.189
-Ingxaki yentliziyo 72 (11.0) 200 (10.2) 0.554
–Ingxaki yokuphefumla 71 (10.8) 305 (15.5) 0.003
– Ezinye iingxaki zotyando/zonyango 1 (0.2) I-11 (0.6) 0.315
Inkqubo yokwetyisa, n (%) 825 2475
– Usulelo lwemiphunga 18 (2.2) 87 (3.5) 0.059
-Ingxaki yentliziyo 11 (1.3) 91 (3.7) 0.008
–Ingxaki yokuphefumla 44 (5.3) 156 (6.3) 0.321
– Ezinye iingxaki zotyando/zonyango 3 (0.4) 4 (0.2) 0.377
Inkqubo yeHepatobiliary kunye ne-pancreas, n (%) 122 367
– Usulelo lwemiphunga 10 (8.2) 26 (7.1) 0.684
-Ingxaki yentliziyo 3 (2.5) 17 (4.6) 0.430
–Ingxaki yokuphefumla 8 (6.6) 26 (7.1) 0.843
– Ezinye iingxaki zotyando/zonyango 0 (0.0) 0 (0.0) NA
Inkqubo ye-Musculoskeletal kunye ne-connective tissue, n (%) 3725 11,176
– Usulelo lwemiphunga 26 (0.7) 90 (0.8) 0.519
-Ingxaki yentliziyo 27 (0.6) 137 (1.2) 0.003
–Ingxaki yokuphefumla 68 (1.8) 181 (1.6) 0.396
– Ezinye iingxaki zotyando/zonyango 8 (0.2) I-15 (0.1) 0.333
I-Endocrine, isondlo kunye nenkqubo ye-metabolic, n (%) 582 1747
– Usulelo lwemiphunga 3 (0.5) 16 (0.9) 0.436
-Ingxaki yentliziyo 1 (0.2) Ishumi elinesixhenxe (1.0) 0.056
–Ingxaki yokuphefumla 9 (1.6) 27 (1.6) 1
– Ezinye iingxaki zotyando/zonyango 1 (0.2) 4 (0.2) 1
Izintso kunye nomjelo womchamo, n (%) 265 795
– Usulelo lwemiphunga 5 (1.9) 27 (3.4) 0.214
-Ingxaki yentliziyo 1 (0.4) 31 (3.9) 0.002
–Ingxaki yokuphefumla 16 (6.0) 43 (5.4) 0.699
– Ezinye iingxaki zotyando/zonyango 1 (0.4) 2 (0.3) 1
Inkqubo yokuzala yamadoda, n (%) 151 453
– Usulelo lwemiphunga 1 (0.7) 1 (0.2) 0.438
-Ingxaki yentliziyo 1 (0.7) 4 (0.9) 1
–Ingxaki yokuphefumla 1 (0.7) 3 (0.7) 1
– Ezinye iingxaki zotyando/zonyango 1 (0.7) 1 (0.2) 0.348
Inkqubo yokuzala yabasetyhini, n (%) 371 1113
– Usulelo lwemiphunga 4 (1.1) I-11 (1.0) 1
-Ingxaki yentliziyo 1 (0.3) 12 (1.1) 0.205
–Ingxaki yokuphefumla 7 (1.9) 23 (2.1) 1
– Ezinye iingxaki zotyando/zonyango 2 (0.5) 0 (0.0) 0.62

Amaxabiso axelwa njengenani (umyinge).

†Ibonisa uvavanyo oluchanekileyo lukaFisher.

Uhlalutyo lobuthathaka

Iimeko ze-88 ze-DL kunye neemeko ze-264 ze-VL zifakwe kuhlalutyo lobuntu.Uluhlu lwe-LOS lwaluyi-1-106 yeentsuku zeqela le-VL, kunye ne-1-71 iintsuku zeqela le-DL, kumaqela alishumi e-MDC.Iqela le-VL lalinomlinganiselo omfutshane wesibhedlele i-LOS (11.2 vs 14.7 iintsuku, p = 0.049), kunye nenqanaba lokungeniswa kwe-ICU emva kokuhlinzwa (49.2% [n = 130/264], vs 61.4% [n = 54/88], p = 0.049) xa kuthelekiswa neqela le-DL.Umyinge weendleko zokulala ezigulayo zaziphantsi kwiqela le-VL xa kuthelekiswa neqela le-DL, nangona umehluko wawungabalulekanga ngokwezibalo (i-$ 56,384 vs $ 57,287, p = 0.913).Kwakungekho mahluko abalulekileyo ngokwezibalo kumazinga okuxakeka phakathi kwe-VL ne-DL (Uluhlu 6).

Uluhlu 6.Iindleko zizonke, ezijongwayo nezilungelelaniselwe ukubhidanisa imiba.
Inqaku lokugqibela Iilaryngoscopes zevidiyo (n = 264) Iilaryngoscopes ezithe ngqo (n = 88) p-ixabiso
Iindleko zilonke, iUS$, intsingiselo (SD) $56,384 ($87,696) $57,278 ($57,518) 0.913
Ubude bokuhlala, iintsuku, kuthetha (SD) 11.2 (14.8) 14.7 (14.0) 0.049
Postoperative ICU, n (%) 130 (49.2) 54 (61.4) 0.049
Usulelo lwemiphunga, n (%) 36 (13.6) 116 (12.5) 0.786
Iingxaki zentliziyo, n (%) 20 (7.6) 7 (8.0) 0.908
Iingxaki zokuphefumla, n (%) 33 (12.5) I-10 (11.4) 0.778
Ezinye iingxaki zokhathalelo lwezonyango n (%) 2 (0.8) 0 (0.0) 0.413

Amaxabiso axelwa njengentsingiselo (SD) okanye inani (umlinganiselo).

ICU: Icandelo labagula kakhulu;N: Inani;SD: Ukutenxa eMgangathweni.

Ingxoxo

I-Laryngoscopy ye-tracheal intubation ayifane idibaniswe neengxaki, kodwa xa iingxaki zenzeke, zinokuba nzima, zibulale kwaye zingenakuguqulwa.I-intubations enzima kunye neyokungaphumeleli inxulumene neziphumo ezibi, kubandakanya i-hypoxemia, i-bronchospasm, i-airway trauma, i-hypertension, i-arrhythmias, ukubanjwa kwentliziyo, umonakalo we-neurologic, ukungena kwi-ICU engacwangciswanga kunye nokufa.4,17].Amaxabiso e-intubation enzima kwaye engaphumelelanga anciphile kwiminyaka yakutshanje njengoko izikhokelo ezitsha kunye nezixhobo ziye zaziswa ekusebenzeni kweklinikhi [18].Kubalulekile ukuqhubeka neenzame zokwandisa ukhuseleko lwe-laryngoscopy kunye ne-tracheal intubation.

Uphononongo oluninzi lubonise ukuba i-VL ibonelela ngembono yeglottic engcono kwaye inciphisa inani leenzame zokungaphumeleli zokuthelekisa ne-DL [3].Uphononongo lwe-2016 Cochrane lwezilingo ze-38 ezibandakanya abathathi-nxaxheba be-4127 bagqiba ukuba i-VL yanciphisa kakhulu i-frequency ye-intubations engaphumelelanga xa kuthelekiswa ne-DL [3].Ukuncipha kweziganeko zokungaphumeleli kwe-intubations kwakubaluleke kakhulu kwizifundo zezigulane ezineendlela zomoya ezilindelekileyo okanye ezifanisiweyo [3].I-VL iyacetyiswa kwizikhokelo ezininzi zendlela yomoya [7,19,20], kwaye isetyenziswa ngokuqhelekileyo kwaye ibonise izinga eliphezulu lokuphumelela xa lisetyenziswa njengendlela yokuhlangula emva kokungaphumeleli kwe-DL [6,11,21].Nangona kunjalo, nangona iinzame zokuchonga iindlela zomoya ezinokuba nzima ngaphambi kokuba kufakwe intubation, uninzi lwee-intubations ezinzima azilindelwanga [4,8,9,22].Oku kuphakamisa inzuzo enokubakho ekusebenziseni i-VL nangona intubation enzima ingazange icingelwe [10,11].I-VL iya inconywa kwaye isetyenziswa njengenxalenye yesicwangciso somgca wokuqala kwiimeko eziqhelekileyo zokufukamela [10,13,23,24], kwaye kukho ubungqina obuxhasa iingenelo zayo kwizigulana ezineendlela zomoya ezingekho nzima [25].

Kuncinci okuqondwayo malunga nefuthe le-VL kunye ne-DL kwiziphumo zoqoqosho lwezempilo kwizigulane eziphantsi kweenkqubo zotyando ezikhethiweyo.Uphononongo oluqhutywe ngu-Alsumali kunye noogxa basebenzisa imodeli yomthi wesigqibo esifanisiweyo safumanisa ukuba i-VL yayanyaniswa nokunciphisa iziganeko ezimbi kwaye kukho i-$ 3429 egcinwe kwisiganeko esibi esithintelweyo kwisilungiselelo segumbi lokusebenza [26].Olunye uphononongo lweqela lokubuyela umva olwenziwe nguMoucharite kunye noogxa babonise intubations enzima kunye neyasilelayo ikwanxulunyaniswa neendleko eziphezulu zezigulane kunye ne-LOS [27].Injongo yolu phononongo lwangoku yayikukuhlalutya idatha yehlabathi lokwenyani evela kwiNkulumbuso yeDatha yezeMpilo, emele malunga ne-25% yazo zonke izigulane zase-US ezilaliswa kwizigulane, ukuzalisa esi sikhewu.Lo bungakanani besampulu bukhulu buvumela amandla awoneleyo ofundo lweengxaki ezingaqhelekanga ezinxulumene ne-tracheal intubation.Ekubeni inkqubo eyinkimbinkimbi, iindleko kunye neziphumo zesigulane kulindeleke ukuba zihluke kakhulu phakathi kwamaqela e-MDC, uhlalutyo lomelezwe ngokwenza uthelekiso kwinqanaba leqela leMDC.Amaqela e-MDC aye asekwa ngokwahlula-hlula zonke izifo ezinokubakho kwiinqununu zibe ziindawo ezingama-25 ezikhethekileyo zokuxilongwa.Uxilongo kwi-MDC nganye luhambelana nenkqubo yeziko elinye okanye i-etiology kwaye ngokubanzi inxulunyaniswa nengcali ethile yezonyango.Ukhathalelo lweklinikhi luququzelelwe ngokubanzi ngokuhambelana nenkqubo yamalungu achaphazelekayo.Ukusebenzisa amaqela eMDC kwasinceda ukuba sinciphise inani leenkqubo zotyando ezibandakanyiweyo ngaphandle kokunciphisa uhlalutyo kwiintlobo ezithile zotyando.

Xa sithelekisa iimpawu zesigulane kunye nezibhedlele phakathi kwezigulane ezifumana i-DL okanye i-VL, siye sabona iiyantlukwano ezininzi ezibalulekileyo.Izigulane eziselula, amadoda okanye eCaucasian kwakunokwenzeka ukuba zifumane i-VL, kwaye izigulane kwizibhedlele zokufundisa okanye kwimimandla yaseMidwest okanye eNtshona ye-US ziyakwazi ukufumana i-VL.Umahluko ekusetyenzisweni kwe-VL mhlawumbi ubonisa kungekuphela nje iiyantlukwano kwisidingo sokusebenzisa i-VL kwizigulana ezithile, kodwa zinokubonisa ukwamkelwa okukhawulezileyo kobuchwepheshe obutsha kunye noqeqesho ngokuxhomekeke kubuchule bokufundisa besibhedlele kunye nendawo yaso yengingqi.Ngokufanayo, iiyantlukwano ekusebenziseni i-VL kuzo zonke iintlanga zingabonakalisa ukungafani kwizinto ezikhethwa ngumntu ngamnye kunye neempawu zesibhedlele, kubandakanywa nobukhulu, ummandla kunye namandla okufundisa.Ukongezelela ekulawuleni uluhlu lweempawu zesigulane kunye nezibhedlele, uhlalutyo lwe-multivariate olulawulwa ngexesha le-anesthesia, uphawu olunokuthi lube nobunzima.

Olu phononongo lubonise iziphumo eziphuculweyo zezoqoqosho kunye ne-VL xa kuthelekiswa ne-DL kwizigulane ezenza utyando olukhethiweyo kwindawo yokugula kwaye ziqinisekisile iziphumo ze-Alsumali.okqhubekayo.[26].Umndilili weendleko zezigulane ezilalisiweyo bezisezantsi kakhulu kwizigulane ezinyangwe nge-VL kune-DL kumaqela asibhozo kwalishumi e-MDC.Ukongiwa kweendleko kwisiganeko ngasinye sezigulane ezilaliswayo kuphakathi kwe-$1144 ukuya kwi-$5891, kuxhomekeke kwiqela leMDC.Iindleko ezincitshisiweyo zingabonakalisa iziphumo eziphuculweyo zesigulane, njengoko i-VL nayo idibaniswe nesibhedlele esifutshane se-LOS, kunye ne-avareji yokuhlala iyancipha ibe ngaphezu kwe-1 ngosuku kwisiqingatha samaqela e-MDC.Okuqaphelekayo, amathuba okuba amkelwe emva kotyando kwi-ICU abesezantsi kakhulu kwi-VL kune-DL kuwo onke amaqela alishumi e-MDC.I-VL nayo yadityaniswa nokuba nokwenzeka okusezantsi kwentliziyo kunye neengxaki zokuphefumla kumaqela amathandathu kunye namathathu alishumi e-MDC, ngokulandelanayo.Ngokubanzi, olu hlalutyo lubonisa inzuzo ngokubanzi ekusebenziseni i-VL kwiinkqubo zotyando ezikhethiweyo kwindawo yokulala, ebonakaliswe kwiindleko ezincitshisiweyo, i-LOS emfutshane kunye nokunciphisa amathuba okuba neengxaki kunye nokwamkelwa kwe-ICU emva kokuhlinzwa.

Siqaphela imida emininzi yophononongo.Okokuqala, kukuhlaziywa kwedatha esetyenziselwa iinjongo zolawulo, ukuhlawula kunye nokubuyisela.Akukho CPT / HCPCS okanye i-ICD-10 iikhowudi zenkqubo yokuhlinzwa ukuze zichonge ngokuthe ngqo indlela ye-intubation esetyenziswayo ngexesha lotyando.Indlela yokukhangela igama elingundoqo inokungaphumeleli ukuchonga zonke izigulane ngenxa yokungaphelelanga koluhlu lwegama elingundoqo okanye isibhedlele esingaphantsi kwengxelo yemigaqo ngenxa yentlawulo edibeneyo yemisebenzi yesiqhelo yeklinikhi.Kolu phononongo, sifumene ukuba iinkqubo ze-DL zaziphantsi kakhulu.Ukufakwa kwezigulane kwiqela le-DL elibhedlele umgca wokuhlawula esibhedlele alizange lichaze uhlobo lwe-laryngoscopy lunokubangela ukungahambi kakuhle kwezinye izigulane ezifumana i-VL njenge-DL, okubangelwa iqela le-DL elingafaniyo kunye nokwenza ukungafani phakathi kwamaqela kunzima ukukubona.Senze uhlalutyo lovakalelo sisebenzisa iimeko eziqinisekisiweyo ze-VL kunye ne-DL ukujongana nalo mda, obangele iziphumo ezifanayo.Kwakhona kunokwenzeka ukuba ezinye izigulane ezineemeko zomoya ezixhaphakileyo ezinokuthi zixhamle kwi-VL ngokwenene zifumene i-DL, ezinokuthi zinyuse amathuba, kunye nokuhluka okwenzekayo, kwiingxaki zasemva kokuhlinzwa kwiqela le-DL.Okubalulekileyo, uhlalutyo lwethu lwedatha yolawulo luxhomekeke kwidatha yehlabathi lokwenyani, kunye nezigulane ezifumana umgangatho wokunakekelwa kwesibhedlele.Ngoko ke, ukuvela okuphantsi kweengxaki kwizigulane ezine-VL ezibonwe kolu phononongo lubonisa iimeko zehlabathi zangempela ezenzeka kwindawo yotyando, kungakhathaliseki ukuba i-VL kufuneka isetyenziswe kwiimeko ezithile zezigulane ezineemeko zomoya ezikhoyo.Ukongezelela, nangona sahlula izigulane ngeqela le-MDC, iqela ngalinye le-MDC libandakanya uluhlu olubanzi lweenkqubo ezinokuchaphazela iziphumo zesigulane, ubude bokuhlala kunye neendleko.Uhlalutyo lwethu lugxile kwisigulane esiqhelekileyo kwiqela ngalinye le-MDC, ngokuchasene neemeko zenkqubo ethile, apho kunokubakho ukuhluka okuphawulekayo kwiziphumo zempilo.Izifundo ezilindelekileyo zexesha elizayo zinokuwoyisa lo mda.Izifundo zexesha elizayo zinokuphonononga ukuba nini kwaye kutheni i-VL ikhethwa ngaphezu kwe-DL, kuquka ukuba ifumaneka kangaphi i-VL ukuze isetyenziswe ngabathomalalisi.

Olunye umda kukuba i-database ayinalo ulwazi malunga nemiba ethile yenkqubo ye-intubation ngokwayo, njengenani lemizamo, ixesha lokungena, okanye izinga lokuqala lokuphumelela, elinokuchaphazela iziphumo zesigulane.Umzamo wokusebenzisa iikhowudi zokuxilongwa kwe-ICD-10 ukuchonga umonakalo wezicubu ezithambileyo kunye namazinyo kunye ne-intubation enzima ifumene isiganeko esiphantsi kakhulu sedatha echazwe, enokuthi ibangelwa ukubamba okungaphelelanga kunye nekhowudi (idatha engaboniswa).I-database ayizange iphendule kwimiba yengozi yesigulane kwi-intubation ye-tracheal enzima njengeqondo lokuvula umlomo, iklasi ye-Mallampati, umgama we-thyromental kunye nokunyakaza kwentamo, enokuthi ibe nefuthe kwisicwangciso se-intubation kagqirha kunye nefuthe kwiziphumo zesigulane.I-database yolawulo nayo ayizange ibandakanye ulwazi lwezonyango lwezigulane ezifana nokuhlelwa kwe-ASA, ukwenza uvavanyo lwezinto zonyango lwesigulane ngaphandle kohlalutyo lwangoku.Ekugqibeleni, ukuhlolwa kweempembelelo zexesha elide zeendlela ze-intubation zazingaphaya kwendawo yolu phononongo.Impembelelo ye-VL xa ithelekiswa ne-DL ekusetyenzisweni kwexesha elide lokhathalelo lwempilo okanye umgangatho wobomi, obuchatshazelwa kukonakala kwengqondo okanye izehlo zenyumoniya ezinqwenelekayo ezibangelwa kukungenwa nzima, kufanelekile ukuphononongwa kwixesha elizayo.

Ukuqukumbela

Ekugqibeleni, olu hlalutyo lubonisa ukuba kunokubakho ukuphuculwa kweziphumo zoqoqosho lwezempilo usebenzisa i-VL xa kuthelekiswa ne-DL kumaqela amaninzi e-MDC.Nangona singenako ukufikelela kwisigqibo esiqinisekileyo de kugqitywe uphononongo oluqhubekayo, iziphumo zibonisa ukuba i-VL inokukhethwa kune-DL kwiinkqubo zotyando ezikhethiweyo kwindawo yokulalisa.Olu hlalutyo lukwaqaqambisa imfuneko yokubhalwa kwamaxwebhu afanelekileyo eendlela ze-laryngoscopy, kuba malunga ne-10% yeemeko ezichazwe kwiinkcukacha zokuhlawula nokuba i-VL okanye i-DL yayisetyenzisiwe, kwaye ngaphantsi kwe-0.15% echazwe xa i-DL yayisetyenziswa.Sincoma ukuba oogqirha kunye neenkqubo ze-EMR zandise iinzame zabo zokubhala ulwazi lwe-laryngoscopy, kubandakanywa nendlela, inani lemizamo ye-intubation kunye nempumelelo-ukungaphumeleli kunye nomzamo wokuqala wokuthotyelwa kwe-intubation ukwenzela ukuququzelela izifundo ezizayo ngokuthelekisa iindlela ze-laryngoscopy.

Amanqaku ashwankathelayo

  • Nangona kukho izibonelelo zeklinikhi ezisekelwe kakuhle zevidiyo ye-laryngoscopy (VL) ngaphezu kwe-laryngoscopy ethe ngqo (DL) kwigumbi lokusebenza, iziphumo zoqoqosho lwezempilo ze-VL ngokuchasene ne-DL azichazwanga.
  • Olu phononongo luthelekisa iindleko ezipheleleyo zezigulane, ubude besibhedlele (i-LOS), izinga lokungeniswa kwiyunithi yokunyamekela kakhulu (ICU) kunye namazinga obunzima phakathi kwezigulane ezifumene i-VL kunye ne-DL kwigumbi lokusebenza kwiinkqubo zokuhlinzwa.
  • Uhlalutyo olulawulwayo ngokungafaniyo kwi-demographics yezigulane kunye neempawu zeklinikhi, kunye neempawu zesibhedlele kunye nohlobo lwenkqubo ngokuthelekisa izigulane kwiindidi ezifanayo zokuxilonga (MDC).
  • Kwiqela elihlengahlengisiweyo, iindleko ze-inpatient ze-VL zaziphantsi kakhulu kune-DL kwisibhozo samaqela e-MDC alishumi, kunye nokwahlukana kweendleko phakathi kwe-$ 1144 ukuya kwi-$ 5891 phakathi kwe-VL kunye namaqela e-DL.
  • Xa kuthelekiswa neqela le-DL, umyinge we-LOS wawuphantsi kakhulu kwiqela le-VL kumaqela asibhozo e-MDC alishumi, kunye namaqela amahlanu e-MDC ene->1 imini ye-LOS yokunciphisa izigulane kwiqela le-VL.
  • Amathuba okwamkelwa e-ICU emva kotyando ebesezantsi kakhulu kuwo onke amaqela alishumi e-MDC, kwiqela le-VL xa lithelekiswa neqela le-DL.
  • Amazinga okuxhatshazwa kwintsholongwane ye-pulmonary, i-cardiovascular complications kunye neengxaki zokuphefumula, zaziphantsi kwiqela le-VL ngokuchasene neqela le-DL kumaqela amaninzi e-MDC.
  • Ngokubanzi, olu phononongo lucebisa ukuba iziphumo zoqoqosho lwezempilo ziphuculwe kwizigulane ezifumana i-VL ngokuchasene ne-DL kwindawo yotyando lwezigulane ezilaliswayo, ebonisa inzuzo yokusebenzisa i-VL kwiinkqubo zotyando ezikhethiweyo.
  • Uhlalutyo olulindelekileyo lokuthelekisa iziphumo zoqoqosho lwezempilo kwizigulane ezifumana i-VL ngokuchasene ne-DL ziyafuneka ukuze kuqinisekiswe iziphumo zolu phononongo.

Idatha eyongezelelweyo

Ukujonga idatha eyongezelelweyo ehamba kunye neli phepha nceda undwendwele iwebhusayithi yejenali apha:www.futuremedicine.com/doi/suppl/10.2217/cer-2021-0068

Iminikelo yombhali

Bonke ababhali benza igalelo elikhulu ekufundeni ukukhulelwa kunye nokuyila, ukukhangela abantu kunye nokufumana idatha kunye / okanye uhlalutyo lwedatha kunye nokutolika (J Zhang, W Jiang kunye noF Urdaneta);uthathe inxaxheba ekuqulunqeni umbhalo wesandla (J Zhang) kunye / okanye ukuwuhlaziya ngokubalulekileyo umxholo obalulekileyo wobukrelekrele (W Jiang, F Urdaneta);wanika imvume yokugqibela yenguqulelo yokugqibela yombhalo-ngqangi engeniswe ukuba ipapashwe (J Zhang, W Jiang, F Urdaneta);kwaye uvume ukuba uphendule kuzo zonke iinkalo zomsebenzi (J Zhang, W Jiang kunye noF Urdaneta).

Imibulelo

Ababhali bangathanda ukubulela i-T Golden (i-Golden Bioscience Communications) ngoncedo lokubonelela ngenkxaso yokubhala unyango kunye ne-M Thapa (Medtronic) ngokubonelela ngenkxaso yokuhlela / yokufomatha.

Ukubhengezwa kwemidla yezemali nokhuphiswano

U-J Zhang kunye no-W Jiang banika ingxelo yengqesho kunye ne-Medtronic;U-F Urdaneta yinxalenye yeBhodi yeeNgcebiso kwi-Vyaire Medical kunye nomcebisi we-Medtronic kwaye ufumana i-honoraria yesithethi kubo bobabini.Ababhali abanalo olunye unxulumano olufanelekileyo okanye ukubandakanyeka kwemali kunye nawo nawuphi na umbutho okanye iqumrhu elinomdla wemali okanye ukungqubana kwezemali kunye nombandela okanye izinto ezixutyushwa kumbhalo-ngqangi ngaphandle kwezo zichaziweyo.

T Golden, (uNxibelelwano lweGolden Bioscience) unikezele ngenkxaso yokubhala ngonyango kunye no-M Thapa (Medtronic) babonelele ngenkxaso yokuhlela / yokufomatha, bobabini baxhaswa ngemali yi-Medtronic.

Ukuziphatha okusesikweni kophando

Ababhali bachaza ukuba imvume yebhodi yokuphonononga iziko yayikhululiwe ngenxa yokuba idatha ehlalutyiweyo yayichongiwe kwaye isifundo asizange sibandakanye ngqo izifundo zabantu (45 CFR § 46.0001 (b) (4)).Uphononongo lwaluhambelana nemigaqo echazwe kwiSibhengezo saseHelsinki kunye noMthetho wokuThuthwa kwe-Inshurensi yezeMpilo kunye nokuPhendula (HIPAA) kulo lonke uphando lwabantu.

Ingxelo yokwabelana ngedatha

Idatha yolu phononongo isetyenziswe phantsi kwelayisensi kwaye inokufumaneka kwiPremier Inc.

Vula ukufikelela

Lo msebenzi unelayisensi phantsi kwe-Attribution-NonCommercial-NoDerivatives 4.0 Ilayisensi engathunyelwanga.Ukujonga ikopi yeli layisensi, ndwendwelahttp://creativecommons.org/licenses/by-nc-nd/4.0/

 


Ixesha lokuposa: 06-09-22