Isesengura ryubukungu ryikoreshwa rya videwo laryngoscopi na laryngoscopi itaziguye muburyo bwo kubaga

AMAKURU1

Ibisobanuro

Intego: Ugereranije na laryngoscopi itaziguye (DL), videwo laryngoscopi (VL) itanga inyungu zubuvuzi mumyuka isanzwe kandi igoye.Inyungu zubukungu bwubuzima bwa VL na DL kubikorwa bisanzwe bya tracheal intubation ntikiramenyekana.Ibikoresho & uburyo: Iri sesengura ryagereranije ibyavuye mu bukungu bwa VL na DL, harimo amafaranga yose y’abarwayi, igihe cyo kumara ibitaro (LOS), ishami rishinzwe ubuvuzi bukomeye nyuma yo kubagwa (ICU) hamwe n’ibibazo biterwa n’uburyo bukurikirana.Ibisubizo: Abarwayi bafite VL bari bagabanije igiciro cy’abarwayi (US $ 1144–5891 US $ mu byiciro umunani byingenzi byo gusuzuma [MDC]);> Kugabanya umunsi 1 LOS muri MDC eshanu;yagabanije amahirwe yo kwinjira muri ICU nyuma yo gutangira (0.04–0.68) no kugabanya ibibazo byubuhumekero muri MDC eshatu (0.43–0.90).Umwanzuro: Video laryngoscopy irashobora kugabanya ibiciro byose, kugabanya LOS no kugabanya amahirwe yo kwinjira nyuma yo gutangira ICU.

Shyira ahagaragara

Muri ubu bushakashatsi, twagereranije itandukaniro ryibiciro byibitaro, igihe cyo kumara ibitaro, ingorane nyuma yo kubagwa hamwe n’ishami ry’ubuvuzi bukomeye nyuma yo kubagwa (ICU) hagati y’amatsinda abiri y’abarwayi.Amatsinda yombi y’abarwayi yinjiye mu bitaro kugira ngo abone uburyo bwo kubaga kandi batewe aneste muri rusange byibura 1 h.Mbere yo gutanga anesthesia yo kubagwa, anesthesiologue yinjiza umuyoboro mumuyaga wumurwayi kugirango uhumeke umurwayi.Anesthesiologue arashobora gukoresha ubwoko butandukanye bwa laryngoscope kugirango afashe kwinjiza igituba.Guhitamo ubwoko bwa laryngoscope bushingiye ku bintu byinshi nko kuboneka kw'igikoresho, uburambe bwa muganga, ibyo ukunda ndetse n'ubuvuzi bw'umurwayi ndetse n'umubiri.Ubu bushakashatsi bwibanze ku bwoko bubiri bwa laryngoscopes: videwo laryngoscope na laryngoscope.Abarwayi bakiriye videwo laryngoscope cyangwa laryngoscope itaziguye bagabanijwe mu matsinda atandukanye.Twiyemeje neza ko ayo matsinda yombi y’abarwayi yagereranywa ukurikije imyaka, igitsina ndetse n’indwara, baguma mu bitaro bisa kandi bafite uburyo bumwe.Ugereranije nitsinda rya laryngoscope itaziguye, itsinda rya videwo ya laryngoscope yari ifite amafaranga make yibitaro (yagabanutseho amadorari 1144-5891 USD), byibuze byibura iminsi 1 yo kumara ibitaro, kugabanya umubare w’abinjira muri ICU nibibazo bike.Ubu bushakashatsi bwerekana ko videwo laryngoscopy itanga inyungu zirenze laryngoscopi yuburyo bwo kubaga bwatoranijwe.

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Tweetable abstract

Video laryngoscopi ifitanye isano no kugabanya ibiciro byibitaro, igihe gito cyo kumara, igipimo cyo hasi cya ICU hamwe ningorane nke ugereranije na laryngoscopi itaziguye.#videolaryngoscopy #ubukungu.

Laryngoscopy hamwe na tracheal tube gushyira ni uburyo busanzwe hamwe nibibazo bidasanzwe ariko bishobora kuba bikomeye.Mu mwaka wa 2010, byagereranijwe ko imiyoboro ya tracheal yakoreshejwe mu gihe cyo kubagwa miliyoni 15 muri Amerika [1].Intubation igoye kandi yananiwe kugaragara mubibazo bitarenze 6% na 0.3% byimanza, kandi birashoboka cyane ko byihutirwa mubyihutirwa cyangwa byihutirwa kuruta mubyumba byo gukoreramo [2,3].Nubwo ibyorezo byabo ari bike, mugihe ingorane zijyanye no gutera intubation zigoye kandi zananiwe, zirashobora kudasubirwaho kandi zica [4].Mu bushakashatsi bwakozwe muri Amerika, 2,3% by'impfu ziterwa na anesteziya zatewe no kunanirwa cyangwa bigoye;5].Kubwibyo, kumenya iterambere kugirango wongere intubation tracheal intsinzi numutekano nibyingenzi mubitaro.

Kwinjiza amashusho ya laryngoscopy (VL) mubikorwa byubuvuzi byerekana iterambere rikomeye.Bitandukanye na laryngoscopi itaziguye (DL) ishingiye kumurongo utaziguye wo kubona uburyo bwo gufungura glottic, VL ikoresha uburyo butaziguye, ikohereza amashusho kuva kumutwe wicyuma kugirango irusheho kubona neza ifungura rya glottic.Ubushakashatsi bwinshi bwerekanye ko VL igabanya kwandura intubation igoye kandi iruta abarwayi bafite inzira zihumeka ziteganijwe [3].Gukoresha VL birasabwa cyane mubuyobozi bwumuhanda nkubuhanga bwibanze bwa intubation kandi nkuburyo bwo gutabara iyo DL yananiwe [6,7].Ibyinshi mubintu bigoye intubation bitunguranye nubwo bisuzumwa bihagije [4,8,9].Kubwibyo, agaciro gashoboka ko gukoresha VL nkumurongo wambere inzira ni ikiganiro gifatika [10–14].

Ubu bushakashatsi bwa retrospective cohort bwakozwe kugirango hasesengurwe ibyavuye mu mavuriro n’ubukungu bya VL na DL mu itsinda ry’abarwayi bari mu cyumba cyo kubamo.Ubushakashatsi bwakoresheje ububiko bw’ubuzima bwa mbere bw’ubuzima, bugereranya hafi 25% by’abinjira muri Amerika buri mwaka.Harimo abarwayi benshi, ubwoko bwuburyo bwo kubaga hamwe nibidukikije byibitaro, bigatuma biba umutungo mwiza wo kugereranya ibyavuye mubikorwa bitandukanye nka DL na VL.Ibyavuye mu bushakashatsi birashobora gutanga amakuru kubaganga batekereza niba VL igomba gufatwa hejuru ya DL nkuburyo bwambere bwo kwanduza tracheal.

Ibikoresho & uburyo

Igishushanyo mbonera

Twakoze ubushakashatsi bwisubireho bwihuriro dukoresheje imyaka 3 yamakuru (2016–2018) duhereye kububiko bwibanze bwubuzima.Ububikoshingiro bwa mbere bwita ku buzima bufatwa nk’ubusonerwe bw’ubuyobozi bushinzwe kugenzura ibigo nk'uko biteganywa n’umutwe wa 45 w’amategeko ngengamikorere ya Leta, Igice cya 46 cy’Amerika, cyane cyane 45 CFR 46.101 (b) (4).Dukurikije amategeko y’ubwishingizi bw’ubuzima no kubazwa amategeko agenga ubuzima bwite, amakuru yatangajwe na Minisitiri afatwa nkayamenyekanye kuri 45 CFR 164.506 (d) (2) (ii) (B) binyuze mu buryo bwa 'Determination Determination'.

Guhitamo

Abarwayi bose bakuze babazwe mu buryo bw’indwara aho byibuze 1 h ya anesthesia rusange hamwe na tracheal intubation (bafite ijambo ryibanze rya 'intubation' ushinzwe dosiye nkuru) barabajijwe (n = 72,284,Igishushanyo 1).Ibisabwa kuri 1 h ya anesteziya rusange byari bigamije gukuramo abarwayi babazwe uburyo bworoshye bwo kubaga.Ibihe byihutirwa n’abarwayi batwite ntibashyizwemo kubera ko uburyo bw’amavuriro n’imiterere y’abarwayi bishobora gutandukana cyane n’abantu batoranijwe babaga.Abarwayi bashyizwe mu byiciro 25 by'ingenzi byo gusuzuma (MDC) hashingiwe ku itsinda ryabo rishingiye ku gusuzuma (DRG).Itsinda ryanyuma ryarimo abarwayi bakuze mumatsinda icumi ya mbere ya MDC, bangana na 86.2% byabarwayi bakuze babaga batoranijwe (n = 62,297 / 72,284,Igishushanyo 1).

 

Igicapo 1. Imbonerahamwe yerekana urutonde rwabarwayi. Igishushanyo cyerekana ibipimo ngenderwaho bikoreshwa kugirango ugere kumurwi wanyuma wabarwayi.Kugirango uhindure ingano yuburinganire hagati yitsinda rya DL na VL, abarwayi batoranijwe ku bushake ku kigereranyo cya 3: 1 DL: VL kuri buri MDC, usibye Indwara n’imivurungano yo mu matwi, izuru, umunwa n’umuhogo, muri ikigereranyo cya 2: 1 DL: VL yakoreshejwe kuko hari abarwayi bake cyane mumatsinda ya DL guhitamo kuri 3: 1.

DL: Laryngoscopy itaziguye;MDC: Icyiciro cy'indwara zikomeye;VL: Video laryngoscopy.

Ukurikije ubwoko bwa laryngoscope yakoreshejwe muri intubation, cohort yatandukanijwe mumatsinda ya DL na VL.Ijambo ryibanze ryashakishijwe muri dosiye nkuru yishyurwa ryakoreshejwe kugirango umenye laryngoscope (DL vs VL).Ijambo ryibanze ryarimo guhuza izina ryuwabikoze, izina ryicyuma, ingano, ubwoko hamwe ninteruro 'video laryngoscopy' cyangwa 'laryngoscopi itaziguye' hamwe nincamake zabo (Imbonerahamwe y'inyongera 1).Impuguke mu gusubiza amafaranga yasuzumye urutonde rwamagambo yingenzi kandi yemeza ko ibyiciro ari ukuri.Abarwayi badafite inyandiko zerekana ubwoko bwa laryngoscopi yakoreshejwe bahawe itsinda rya DL.Ibi byakozwe kubera ko DL yakunze guhuzwa muri raporo ya anesthesia muri rusange bityo ikaba itarasobanuwe.Hariho abarwayi benshi barimo DL ugereranije nabakiriye VL muri cohort yacu (n = 55,320 vs 6799).Niyo mpamvu, abarwayi bakira DL batoranijwe ku bushake muri buri tsinda rya MDC ku kigereranyo cya 3: 1 (DL: VL), kugira ngo bagabanye ubusumbane bw’icyitegererezo hagati y’amatsinda mu gihe bakomeza umurwayi n’ibitaro biranga itsinda ryambere rya DL [15,16].Mu matwi ya MDC yo mu matwi, izuru, umunwa, n'umuhogo, igipimo cyari 2: 1 DL: VL kubera ko itsinda rya DL ryari rito cyane ku buryo ritashobora kubyara 3: 1.

Isesengura ryibyiyumvo

Kugirango hamenyekane ko itandukaniro riri hagati yitsinda ritatewe no kutita ku barwayi batewe na DL, hakozwe isesengura ry’imyumvire.Muri iri sesengura, kubuza 1 h igihe cyo kubagwa byavanyweho kugirango hashyirwemo izindi DL.Uburyo bwo guhuza uburyo bwakoreshejwe bwakoreshejwe mu guhuza ibiranga umurwayi n'ibitaro hagati ya DL na VL kuri buri rwego rwa MDC.Umurwayi umwe wo mu itsinda rya DL yamaze igihe kinini mu bitaro (iminsi 472) kandi ntiyakuwe mu isesengura.Uyu murwayi yari afite uburwayi bwa neurologique na epilepsy (kode yambere yo gusuzuma ICD_10: G40.909), kandi kumunsi wibitaro # 123 yakorewe tracheotomie no gushyira igikoresho cya tracheostomy (kode yo kubaga ICD_10: 0B110F4).

Ingamba zagezweho

Ibisubizo by'ibanze byashyizwemo amafaranga yose y’abarwayi, igihe cyo kumara ibitaro (LOS), ishami ryita ku barwayi bakomeye (ICU) hamwe n’ingaruka zijyanye na nyuma yo kubagwa.Kwinjira nyuma ya ICU byasobanuwe nkabarwayi binjiye muri ICU kumunsi cyangwa nyuma yumunsi wo kubagwa.Ibibazo nyuma yo kubagwa byagaragaye hakoreshejwe kodegisi ya ICD-10 yo kwandura ibihaha (J15, J18), ibibazo by'umutima n'imitsi (I20, I21, I24, I46), ibibazo by'ubuhumekero (J98.1, J95.89) n'ibindi bibazo byo kuvura kwa muganga (T88 ) ((Imbonerahamwe y'inyongera 2).

Isesengura mibare

Isesengura rya univariate ryakoreshejwe mu kugereranya imibare fatizo y’abarwayi, ibiranga amavuriro n'ibiranga ibitaro.Ikizamini cya Chi-kare cyangwa Fisher ikizamini nyacyo cyakoreshejwe mubyiciro bitandukanye kandi ikizamini cya Wilcoxon kubihinduka bikomeza.p-indangagaciro zari ebyiri-zifite ibisobanuro bifatika kuri p <0.05.

Itandukaniro ryibiciro byindwara zagereranijwe zagereranijwe ukoresheje igereranyo rusange cyo kugereranya (GEE) hamwe no gukwirakwiza gamma.Uburebure bwahinduwe bwo gutandukana byagereranijwe ukoresheje moderi ya GEE hamwe no gukwirakwiza Poisson.Isubiranamo ryinshi ryakozwe kugirango hamenyekane itandukaniro ryikigereranyo cya ICU nyuma yikigereranyo nigipimo cyingorabahizi.Kubera ko igipimo cy’ingorabahizi ari gake, uburyo bwa Firth bwahaniwe bwakoreshejwe kugirango hagabanuke kubogama ntoya kubigereranyo bishoboka cyane muburyo bwo gusubira inyuma.Ingero zose zagenzuwe kubiranga abarwayi, harimo imyaka y’abarwayi, igitsina, ubwoko, uko abashakanye bameze, indangagaciro ya Charlson n’ubwishingizi bw’ibanze, hamwe n’ibiranga ibitaro, harimo kwigisha ibitaro, ingano yigitanda, uturere tw’ibitaro n’aho biherereye.Isesengura mibare ryose ryakozwe hifashishijwe verisiyo ya SAS 9.4 (SAS Institute Inc, NC, USA).

Ibisubizo

Ibiranga abarwayi & ibitaro

Abarwayi 62.297 bose bujuje ibisabwa byo guhitamo ubushakashatsi.Nyuma yo gutoranya 1: 3 (VL: DL) guhitamo mumatsinda ya DL (1: 2 VL: DL kuburwayi bwamatwi, izuru, umunwa numuhogo MDC), itsinda ryanyuma ryari rigizwe nabarwayi 6799 bakira VL na 20.867 abarwayi bakira DL (Igishushanyo 1).

Imibare y'abarwayi n'ibiranga ivuriro, n'ibitaro biranga abarwayi bo mu matsinda ya VL na DL, barerekanwaImbonerahamwe 1.Ugereranije nitsinda rya DL, abarwayi bakiriye VL bari batoya (impuzandengo yimyaka 60.9 vs imyaka 61.5, p = 0.0007), birashoboka cyane kuba abagabo (52.5% [n = 3666/6977] vs 45.1% [n = 9412 / 20,867], p <0.0001) na Caucase (80.4% [n = 5609/6977] vs 76.2% [n = 15,902 / 20,867], p <0.0001).Ugereranije n'itsinda DL, abarwayi bo mu itsinda rya VL bakunze kwinjira mu bitaro byari icyaro kandi byigisha ibigo (18.9% [n = 1321/6977] vs 11.8% [n = 2463 / 20,867], p <0.0001 na 42,6% [n = 2972/6977] vs 28.9% [n = 1101 / 20,867], p <0.0001 na 24.8% [n = 1731/6977] vs 7.2% [n = 1506 / 20,867], p <0.0001, uko bikurikirana).Impuzandengo ya anesthesia yari ndende mumatsinda ya VL (227 min vs 218 min, p <0.0001).Ikwirakwizwa ry'abarwayi mu matsinda ya MDC ryasaga hagati y'amatsinda ya VL na DL (p = 0.6122).

Imbonerahamwe 1.Ibiranga abarwayi n'ibitaro.
Ibiranga demokarasi y'abarwayi Video laryngoscopy (n = 6977)
Hagati (SD)
Laryngoscopi itaziguye (n = 20,867)
Hagati (SD)
p-agaciro
Imyaka (imyaka) 60.9 (12.9) 61.5 (13.7) 0.0007
n (%) n (%)
Uburinganire <0.0001
- Umugore 3311 (47.5%) 11,455 (54.9%)
- Umugabo 3666 (52.5%) 9412 (45.1%)
Irangamimerere <0.0001
- Arubatse 4193 (60.1%) 12,633 (60.5%)
- Ingaragu 2537 (36.4%) 7918 (37.9%)
- Ibindi 247 (3.5%) 316 (1.5%)
Irushanwa <0.0001
- Caucase 5609 (80.4%) 15,902 (76.2%)
- Umunyamerika - Umunyamerika 688 (9.9%) 3502 (16.8%)
- Ibindi 621 (8.9%) 1356 (6.5%)
- Ntazwi 59 (0.8%) 107 (0.5%)
Ubwoko bw'ubwishingizi <0.0001
- Guverinoma 4135 (59.3%) 11,566 (55.4%)
- HMO / ubucuruzi 2403 (34.4%) 7094 (34.0%)
- Ibindi 371 (5.3%) 1955 (9.4%)
- Kwishingira wenyine 68 (1.0%) 252 (1,2%)
Ibiranga abarwayi Hagati (SD) Hagati (SD)
Igihe cyose cyo gutera anesteziya, min 227 (130.9) 218 (188.5) <0.0001
n (%) n (%)
Indangantego ya Charlson 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 no hejuru 561 (8.0%) 1781 (8.5%)
Icyiciro kinini cyo gusuzuma (MDC), indwara n'indwara za: 0.612
- Ugutwi, izuru, umunwa n'umuhogo 68 (1.0%) 137 (0.7%)
- Sisitemu y'ubuhumekero 212 (3.0%) 636 (3.0%)
- Sisitemu yo kuzenguruka 656 (9.4%) 1968 (9.4%)
- Sisitemu y'ibiryo 825 (11.8%) 2475 (11.9%)
- Sisitemu ya Hepatobiliary na pancreas 122 (1,7%) 367 (1.8%)
- Sisitemu ya musculoskeletal hamwe nuduce duhuza 3725 (53.4%) 11.176 (53,6%)
- Endocrine, imirire na sisitemu ya metabolike 582 (8.3%) 1747 (8.4%)
- Impyiko n'inzira z'inkari 265 (3,8%) 795 (3,8%)
- Sisitemu yimyororokere yumugabo 151 (2,2%) 453 (2,2%)
- Sisitemu yimyororokere yumugore 371 (5.3%) 1113 (5.3%)
Ibiranga ibitaro n (%) n (%)
Aho ibitaro biherereye <0.0001
- Icyaro 1321 (18.9%) 2463 (11.8%)
- Umujyi 5656 (81.1%) 18,404 (88.2%)
Ibitaro byigisha <0.0001
- Oya 4005 (57.4%) 14.829 (71.1%)
- Yego 2972 (42,6%) 6038 (28.9%)
Ingano yigitanda <0.0001
- 000-2299 2929 (42.0%) 6235 (29.9%)
- 300–499 2112 (30.3%) 10,286 (49.3%)
- 500+ 1936 (27.7%) 4346 (20.8%)
Agace k'ibitaro <0.0001
- Hagati y'Uburengerazuba 1820 (26.1%) 1101 (5.3%)
- Amajyaruguru y'Uburasirazuba 487 (7.0%) 1097 (5.3%)
- Amajyepfo 2939 (42.1%) 17.163 (82.2%)
- Iburengerazuba 1731 (24.8%) 1506 (7.2%)

Indangagaciro zitangazwa nkibisobanuro (SD) cyangwa umubare (igipimo).

Ikizamini cya Chi-kare cyakoreshejwe muburyo butandukanye hamwe na t-test yumunyeshuri kubihinduka bikomeza.

DL: Laryngoscope itaziguye;MDC: Icyiciro kinini cyo gusuzuma;SD: Gutandukana bisanzwe;VL: Video laryngoscope.

Igiciro cyose cyindwara

Nyuma yo kugenzura imiterere y’imibare y’abarwayi n’amavuriro n’ibitaro, ugereranije nitsinda rya DL, itsinda rya VL ryagize igiciro cyo hasi cyane ugereranije n’ikigereranyo cy’ibitaro by’abarwayi mu matsinda umunani kuri icumi ya MDC (Igishushanyo 2A).Itandukaniro ryibiciro hagati yitsinda rya VL na DL ryatangiye kuva $ 1144 kugeza $ 5891 mumatsinda umunani MDC.Amatsinda ya MDC hamwe no kuzigama make kandi menshi mu kigereranyo rusange cy’ibiciro by’abarwayi ni Indwara n’imivurungano by’itsinda ry’imyororokere y’Abagabo ($ 13,930 vs $ 15,074, p <0.032), hamwe n’indwara n’indwara zo mu matwi, izuru, umunwa n’umuhogo. ($ 13.485 vs $ 19.376, p <0.0001).Nta tandukanyirizo ryagaragaye mu kigereranyo cy’amafaranga y’abarwayi hagati y’amatsinda ya VL na DL mu ndwara n’imivurungano ya sisitemu yo kuzenguruka ya MDC ($ 45,594 vs $ 44,155, p = 0.1758).


Igicapo ca 2. Igiciro cose c'abarwayi.Impuzandengo yikiguzi cyose cyindwara na 95% CI irerekanwa..Impuzandengo yikigereranyo hamwe no gutandukana bisanzwe birerekanwa.Nta kimenyetso, kidafite akamaro (p ≥ 0.05).VL (utubari twuzuye);DL (fungura utubari).

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

DL: Laryngoscopy itaziguye;MDC: Icyiciro cy'indwara zikomeye;VL: Video laryngoscopy.

Mu isesengura ridakurikijwe, ugereranije nitsinda rya DL, itsinda rya VL ryagize igiciro cyo hasi cyane cy’ibiciro by’abarwayi mu matsinda atatu kuri icumi ya MDC (Igishushanyo 2B).Izi nizo ndwara n’imivurungano bya sisitemu yo kurya ($ 21,021 vs $ 24,121, p = 0.0007), indwara n’imivurungano z’ubuhumekero ($ 25.848 vs $ 31,979, p = 0.0005), n'indwara n'indwara zo gutwi, izuru, umunwa n'umuhogo ($ 15.886 vs $ 21,060, p = 0.017) amatsinda ya MDC.Impuzandengo itagabanijwe igiciro cy’abarwayi yari hejuru mu itsinda rya VL ugereranije nitsinda rya DL mu matsinda abiri ya MDC;indwara n’imivurungano bya sisitemu yimyororokere yumugabo ($ 13.891 vs $ 11,970, p = 0.0019) nindwara n’imivurungano ya sisitemu yimyororokere yumugore ($ 14.367 vs $ 12,041, p = 0.003).

Uburebure bwo kumara

Nyuma yo kugenzura imiterere y’imibare y’abarwayi n’amavuriro n’ibitaro, ugereranije n’itsinda rya DL, itsinda rya VL ryagize ibitaro bigufi byahinduwe LOS mu cyenda mu matsinda icumi ya MDC.Impuzandengo ya LOS itandukaniro ryari rifite imibare mumatsinda umunani kuri icumi ya MDC (Igishushanyo 3A).Igabanuka ryikigereranyo cya LOS ryarenze umunsi 1 mumatsinda atanu ya MDC, harimo indwara nindwara zamatwi, izuru, umunwa numuhogo (iminsi 3.2 vs iminsi 4,6, p <0.0001), nindwara nindwara za sisitemu yumubiri. (Iminsi 8.0 vs iminsi 9.4, p <0.0001).


Igicapo 3. Uburebure bwibitaro byose byo kumara.Impuzandengo LOS na 95% CI irerekanwa.(B) Indorerezi ziteganijwe (zidahinduwe) igihe cyo kumara abarwayi bahabwa DL na VL muri buri tsinda rya MDC.Impuzandengo ya LOS hamwe no gutandukana bisanzwe birerekanwa.Nta kimenyetso, NS (p ≥ 0.05).VL (utubari twuzuye);DL (fungura utubari).

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

DL: Laryngoscopy itaziguye;GUTAKAZA: Uburebure bwibitaro;MDC: Icyiciro cy'indwara zikomeye;NS: Ntabwo ari ngombwa;VL: Video laryngoscopy.

Impuzandengo itagabanijwe LOS yari mugufi cyane mumatsinda ya VL mumatsinda abiri muri icumi ya MDC, indwara n’imivurungano ya sisitemu ya musculoskeletal hamwe nuduce duhuza (2.8 vs 3.0 iminsi, p = 0.0011) n'indwara n'indwara ya sisitemu y'ibiryo (6.0 vs Iminsi 7.0, p = 0.0004).Nta tandukanyirizo rishingiye ku mibare ryagereranijwe mu kigereranyo cya LOS kitagabanijwe ku yandi matsinda ya MDC (Igishushanyo 3B).

Igipimo cya nyuma ya ICU

Mu binjira nyuma ya ICU, 90.1% (n = 878/975), na 87.4% (n = 3077/3521) byabaye mugihe cyumunsi 1 uhereye kubagwa mumatsinda ya VL na DL.

Nyuma yo kugenzura imiterere y’abarwayi n’ibiranga ivuriro n’ibitaro, amahirwe yo kwinjira nyuma yo gutangira ICU yari make cyane (p <0.05) ku itsinda rya VL kuruta itsinda rya DL mu matsinda icumi ya MDC.Ikigereranyo cyahinduwe cyo kwinjiza ICU nyuma yo gutangira kwinjira kuva 0.04 kugeza 0.68 (Imbonerahamwe 2).

Imbonerahamwe 2.Ikigereranyo cyahinduwe kubice byitaweho cyane nyuma yubuvuzi (laryngoscopes itaziguye).
Ibyiciro by'indwara Ikigereranyo cya Odds (95% LCL, 95% UCL)
Ugutwi, izuru, umunwa n'umuhogo 0.166 (0.066, 0418)
Sisitemu y'ubuhumekero 0.680 (0.475, 0.974)
Sisitemu yo kuzenguruka 0.573 (0.455, 0.721)
Sisitemu y'ibiryo 0.235 (0.176, 0.315)
Sisitemu ya Hepatobiliary na pancreas 0.276 (0.139, 0.547)
Sisitemu ya musculoskeletal hamwe nuduce duhuza 0.323 (0.258, 0.404)
Sisitemu ya Endocrine, imirire na metabolike 0.503 (0.309, 0.819)
Impyiko n'inzira z'inkari 0.347 (0.212, 0.569)
Sisitemu yimyororokere yumugabo 0.152 (0.038, 0.618)
Sisitemu yimyororokere yumugore 0.042 (0.016, 0.111)

Indangagaciro zitangazwa nkibipimo bitandukanijwe (munsi-yo hejuru yo kwigirira ikizere).

ICU: Ishami rishinzwe ubuvuzi bukomeye;LCL: Icyizere cyo hasi;UCL: Icyizere cyo hejuru.

Impuzandengo itagabanijwe nyuma yo gukorerwa ICU igipimo cyo kwinjira cyari gito hamwe na VL kuruta DL mu matsinda atandatu muri icumi ya MDC.Itandukaniro ry’abinjira ryinjiye kuva kuri 0.8 kugeza kuri 25.5%, hamwe n’itandukaniro rinini rigaragara mu ndwara n’imivurungano y’amatwi, izuru, umunwa n’umuhogo (VL ​​vs DL, 17,6% [n = 12/68], vs 43.1% [ n = 59/137], p = 0.0003).Nta tandukaniro riri hagati yikigereranyo cya ICU cyo kwinjira cyagaragaye mumatsinda ane asigaye ya MDC (Imbonerahamwe 3).

Imbonerahamwe 3.Igipimo cyo kuvura cyane nyuma yubuvuzi.
Ibyiciro by'indwara Video laryngoscopy (%) Laryngoscopi itaziguye (%) p-agaciro
Ugutwi, izuru, umunwa n'umuhogo 12/68 (17.6) 59/137 (43.1) 0.0003
Sisitemu y'ubuhumekero 100/212 (47.2) 332/636 (52.2) 0.204
Sisitemu yo kuzenguruka 472/656 (72.0) 1531/1968 (77.8) 0.002
Sisitemu y'ibiryo 92/825 (11.2) 567/2475 (22.9) 0.0001
Sisitemu ya Hepatobiliary na pancreas 25/122 (20.5) 132/367 (36.0) 0.0015
Sisitemu ya musculoskeletal hamwe nuduce duhuza 166/3725 (4.5) 597 / 11.176 (5.3) 0.034
Sisitemu ya Endocrine, imirire na metabolike 46/582 (7.9) 121/1747 (6.9) 0.429
Impyiko n'inzira z'inkari 26/265 (16.6) 159/795 (20.0) 0.224
Sisitemu yimyororokere yumugabo 15/7 (4.6) 23/453 (5.1) 0.829
Sisitemu yimyororokere yumugore 11/371 (3.0) 83/1113 (7.5) 0.002

Indangagaciro zitangazwa nkumubare (igipimo).

ICU: Ishami rishinzwe ubuvuzi bukomeye.

Ingorane

Nyuma yo kugenzura imiterere y’abarwayi n’ibiranga ivuriro n’ibitaro, amahirwe yo guhura n’ibibazo bya perioperative yari make hamwe na VL ugereranije na DL mu matsinda menshi ya MDC.Ugereranije abarwayi bahabwa VL n’abarwayi bahabwa DL, amahirwe yo kwandura ibihaha yari make mu matsinda atatu ya MDC, harimo indwara n’imivurungano ya: sisitemu y'ibiryo;sisitemu ya musculoskeletal na tissue ihuza;na endocrine, imirire na metabolike (OR: 0.56, OR: 0.49 na OR: 0.30; p = 0.03123, p = 0.02996, na p = 0.00441);kugira ibibazo byumutima nimiyoboro y'amaraso byari hasi mumatsinda atandatu ya MDC, harimo indwara n'indwara za: sisitemu y'ubuhumekero;sisitemu y'ibiryo;sisitemu ya musculoskeletal na tissue ihuza;indwara za endocrine, imirire na metabolike;impyiko n'inkari;na sisitemu yimyororokere yumugore (OR: 0.28, OR: 0.3, OR: 0.21, OR: 0.12, OR: 0.11 na OR: 0.12; p = 0.00705, p = 0.00018, p = 0.00375, p <0.0001, p = 0.00268 na p = 0.007, uko bikurikirana);kugira ibibazo byubuhumekero byari hasi mumatsinda atatu MDC, harimo indwara nindwara za: sisitemu yo gutembera;sisitemu ya hepatobiliary na pancreas;na endocrine, imirire na metabolike sisitemu (OR: 0.66, OR: 0.90 na OR: 0.43, p = 0.00415, p <0.0001 na p = 0.03245);kugira izindi ngorane zo kubaga / ubuvuzi zari hasi mu itsinda rimwe rya MDC, indwara n’imivurungano ya sisitemu ya hepatobiliary na pancreas (OR: 0.9, p <0.0001) no hejuru mu itsinda rimwe rya MDC, indwara n’imivurungano by’imyororokere y’umugore (OR: 16.04, p = 0.00141) (Imbonerahamwe 4).

Imbonerahamwe 4.Ikigereranyo cyahinduwe kubintu byatoranijwe (laryngoscopes itaziguye).
Ibyiciro by'indwara Indwara y'ibihaha Ingorane z'umutima Ingorane zo guhumeka Ibindi bibazo byo kubaga / ubuvuzi
Indwara n'imivurungano ya: Ikigereranyo cya Odds (95% LCL, 95% UCL)
Ugutwi, izuru, umunwa n'umuhogo 0.18 (0.03, 1.17) 0.34 (0.06, 1.99) 0.85 (0.81, 4.04) 0.69 (0.12, 4.11)
Sisitemu y'ubuhumekero 0.83 (0.50, 1.37) 0.28 (0.11, 0.71) 0.89 (0.56, 1.43) 1.30 (0.42, 4.00)
Sisitemu yo kuzenguruka 1.09 (0,73, 1.62) 1.05 (0,77, 1.42) 0.66 (0.50, 0.88) 0.38 (0.10, 1.40)
Sisitemu y'ibiryo 0.56 (0.33, 0.95) 0.3 (0.16, 0.56) 0,76 (0.53, 1.10) 1.74 (0.60, 5.11)
Sisitemu ya Hepatobiliary na 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)
Sisitemu ya musculoskeletal hamwe nuduce duhuza 0.49 (0.30, 0.89) 0.21 (0.13, 0.33) 0.92 (0,65, 1.3) 0.61 (0.25, 1.46)
Sisitemu ya Endocrine, imirire na metabolike 0.30 (0.10, 0.89) 0.12 (0.03, 0.50) 0.43 (0.20, 0.93) 0.80 (0.22, 2.97)
Impyiko n'inzira z'inkari 0.62 (0.25, 1.55) 0.11 (0.03, 0.46) 0,75 (0.40, 1.42) 3.06 (0,73, 12.74)
Sisitemu yimyororokere yumugabo 0.99 (0.18, 5.6) 0.65 (0.12, 3.36) 1.73 (0.31, 9.55) 0.96 (0.21, 4.34)
Sisitemu yimyororokere yumugore 0.47 (0.15, 1.47) 0.12 (0.02, 0.56) 0,79 (0.30, 2.08) 16.04 (2.92, 88.13)

Indangagaciro zitangazwa nkibipimo bitandukanijwe (munsi-yo hejuru yo kwigirira ikizere).

LCL: Icyizere cyo hasi;UCL: Icyizere cyo hejuru.

Mu ndwara n’imivurungano ya sisitemu yo gutembera mu itsinda rya MDC, igipimo kitagabanijwe cy’ingaruka z’ubuhumekero cyaragabanutse cyane mu itsinda rya VL ugereranije n’itsinda DL (10.8% [n = 71/656], vs 15.5% [n = 305/1968 ], p = 0.003).Mu ndwara n’imivurungano ya sisitemu yo kurya igifu MDC hamwe na sisitemu ya musculoskeletal na tissue ihuza MDC itsinda, igipimo kitagabanijwe cy’ingaruka z'umutima n'imitsi cyagabanutse cyane mu itsinda rya VL ugereranije n'itsinda DL (1.3% [n = 11/825], vs 3,7% [n = 91/2475], p = 0.008; na 0,6% [n = 27/3725], vs 1.2% [n = 137 / 11,176], p = 0.003, uko bikurikirana).Nta tandukanyirizo rindi ryagaragaye mu bipimo bitagoranye byahinduwe hagati ya VL na DL hamwe nandi matsinda ya MDC (Imbonerahamwe 5).

Imbonerahamwe 5.Ingorane ukurikije ibyiciro byingenzi byindwara.
Ingorane Video laryngoscopy (n) Laryngoscopi itaziguye (n) p-agaciro
Ugutwi, izuru, umunwa n'umuhogo, n (%) 68 137
- Indwara y'ibihaha 0 (0.0) 5 (3.7) 0.173
- Ingorane z'umutima 0 (0.0) 4 (2.9) 0.304
- Ingorane zo guhumeka 1 (1.5) 2 (1.5) 1
- Ibindi bibazo byo kubaga / kuvura 0 (0.0) 2 (1.5) 1
Sisitemu y'ubuhumekero, n (%) 212 636
- Indwara y'ibihaha 25 (11.8) 78 (12.3) 0.856
- Ingorane z'umutima 5 (2.4) 38 (6.0) 0.045
- Ingorane zo guhumeka 28 (13.2) 96 (15.1) 0.501
- Ibindi bibazo byo kubaga / kuvura 2 (0.9) 6 (0.9) 1
Sisitemu yo kuzenguruka, n (%) 656 1968
- Indwara y'ibihaha 41 (6.3) 97 (4.9) 0.189
- Ingorane z'umutima 72 (11.0) 200 (10.2) 0.554
- Ingorane zo guhumeka 71 (10.8) 305 (15.5) 0.003
- Ibindi bibazo byo kubaga / kuvura 1 (0.2) 11 (0.6) 0.315
Sisitemu y'ibiryo, n (%) 825 2475
- Indwara y'ibihaha 18 (2.2) 87 (3.5) 0.059
- Ingorane z'umutima 11 (1.3) 91 (3.7) 0.008
- Ingorane zo guhumeka 44 (5.3) 156 (6.3) 0.321
- Ibindi bibazo byo kubaga / kuvura 3 (0.4) 4 (0.2) 0.377
Sisitemu ya Hepatobiliary na pancreas, n (%) 122 367
- Indwara y'ibihaha 10 (8.2) 26 (7.1) 0.684
- Ingorane z'umutima 3 (2.5) 17 (4.6) 0.430
- Ingorane zo guhumeka 8 (6.6) 26 (7.1) 0.843
- Ibindi bibazo byo kubaga / kuvura 0 (0.0) 0 (0.0) NA
Sisitemu ya musculoskeletal hamwe nuduce duhuza, n (%) 3725 11.176
- Indwara y'ibihaha 26 (0.7) 90 (0.8) 0.519
- Ingorane z'umutima 27 (0.6) 137 (1.2) 0.003
- Ingorane zo guhumeka 68 (1.8) 181 (1.6) 0.396
- Ibindi bibazo byo kubaga / kuvura 8 (0.2) 15 (0.1) 0.333
Endocrine, sisitemu yintungamubiri na metabolike, n (%) 582 1747
- Indwara y'ibihaha 3 (0.5) 16 (0.9) 0.436
- Ingorane z'umutima 1 (0.2) 17 (1.0) 0.056
- Ingorane zo guhumeka 9 (1.6) 27 (1.6) 1
- Ibindi bibazo byo kubaga / kuvura 1 (0.2) 4 (0.2) 1
Impyiko n'inzira z'inkari, n (%) 265 795
- Indwara y'ibihaha 5 (1.9) 27 (3.4) 0.214
- Ingorane z'umutima 1 (0.4) 31 (3.9) 0.002
- Ingorane zo guhumeka 16 (6.0) 43 (5.4) 0.699
- Ibindi bibazo byo kubaga / kuvura 1 (0.4) 2 (0.3) 1
Sisitemu yimyororokere yumugabo, n (%) 151 453
- Indwara y'ibihaha 1 (0.7) 1 (0.2) 0.438
- Ingorane z'umutima 1 (0.7) 4 (0.9) 1
- Ingorane zo guhumeka 1 (0.7) 3 (0.7) 1
- Ibindi bibazo byo kubaga / kuvura 1 (0.7) 1 (0.2) 0.348
Sisitemu yimyororokere yumugore, n (%) 371 1113
- Indwara y'ibihaha 4 (1.1) 11 (1.0) 1
- Ingorane z'umutima 1 (0.3) 12 (1.1) 0.205
- Ingorane zo guhumeka 7 (1.9) 23 (2.1) 1
- Ibindi bibazo byo kubaga / kuvura 2 (0.5) 0 (0.0) 0.62

Indangagaciro zitangazwa nkumubare (igipimo).

Yerekana ikizamini nyacyo cya Fisher.

Isesengura ryibyiyumvo

Imanza 88 DL hamwe na 264 VL zashyizwe mubisesengura ryibyiyumvo.Urutonde rwa LOS rwabaye iminsi 1-106 kumatsinda ya VL, niminsi 1-71 kumatsinda ya DL, mumatsinda icumi ya MDC.Itsinda rya VL ryari rifite ibitaro bigufi LOS (iminsi 11.2 vs 14.7, p = 0.049), hamwe n’ikigereranyo cyo hasi ya ICU nyuma yo gutangira kwinjira (49.2% [n = 130/264], vs 61.4% [n = 54/88], p = 0.049) ugereranije nitsinda rya DL.Impuzandengo y'ibiciro by'abarwayi bose bari hasi mu itsinda rya VL ugereranije n'itsinda DL, nubwo itandukaniro ritari rifite imibare ($ 56,384 vs $ 57,287, p = 0.913).Nta tandukanyirizo rishingiye ku mibare ryagaragaye mu bipimo bigoye hagati ya VL na DL (Imbonerahamwe 6).

Imbonerahamwe 6.Muri rusange igiciro, cyarebwaga kandi gihindurwa kubintu bitera urujijo.
Ingingo ya nyuma Video laryngoscopes (n = 264) Laryngoscopes itaziguye (n = 88) p-agaciro
Igiciro rusange, US $, bivuze (SD) $ 56.384 ($ 87,696) $ 57.278 ($ 57.518) 0.913
Uburebure bwo kumara, iminsi, bivuze (SD) 11.2 (14.8) 14.7 (14.0) 0.049
Nyuma yo gutangira ICU, n (%) 130 (49.2) 54 (61.4) 0.049
Indwara y'ibihaha, n (%) 36 (13.6) 116 (12.5) 0.786
Ingorane z'umutima n'imitsi, n (%) 20 (7.6) 7 (8.0) 0.908
Ingorane z'ubuhumekero, n (%) 33 (12.5) 10 (11.4) 0.778
Izindi ngorane zo kubaga ubuvuzi n (%) 2 (0.8) 0 (0.0) 0.413

Indangagaciro zitangazwa nkibisobanuro (SD) cyangwa umubare (igipimo).

ICU: Ishami rishinzwe ubuvuzi bukomeye;N: Umubare;SD: Gutandukana bisanzwe.

Ikiganiro

Laryngoscopi ya tracheal intubation idakunze guhuzwa nibibazo, ariko mugihe habaye ibibazo, birashobora kuba bikomeye, byica kandi bidasubirwaho.Intubations zigoye kandi zananiranye zifitanye isano ningaruka mbi, harimo hypoxemia, bronchospasm, ihahamuka ryumuyaga, hypertension, arththmias, gufatwa k'umutima, kwangirika kw'imitsi, kwinjira kwa ICU bitateganijwe no gupfa [4,17].Ibiciro byintubation bigoye kandi byananiranye byagabanutse mumyaka yashize kuko amabwiriza mashya nibikoresho byinjijwe mubikorwa byubuvuzi [18].Ni ngombwa gukomeza imbaraga kugirango twongere umutekano wa laryngoscopi na tracheal intubation.

Ubushakashatsi bwinshi bwerekanye ko VL itanga icyerekezo cyiza kandi igabanya umubare wabagerageje kugerageza ugereranije na DL [3].Isuzuma rya Cochrane ryo mu 2016 ryerekeye iburanisha 38 ryitabiriwe n’abitabiriye 4127 ryanzuye ko VL yagabanije cyane inshuro za intubations zananiranye ugereranije na DL [3].Kugabanuka kwindwara ziterwa no kunanirwa kwagaragaye cyane mubushakashatsi bw’abarwayi bafite inzira ziteganijwe cyangwa zigereranijwe [3].VL irasabwa mubuyobozi butandukanye bwo guhumeka [7,19,20], kandi irakoreshwa cyane kandi yerekanye igipimo kinini cyo gutsinda mugihe ikoreshwa nkuburyo bwo gutabara nyuma yo gutsindwa kwa DL [6,11,21].Nubwo, nubwo hashyizweho ingufu zo kumenya inzira zoroshye zo guhumeka mbere yubushakashatsi, intubations zigoye ntiziteganijwe [4,8,9,22].Ibi birerekana inyungu zishobora gukoreshwa mugukoresha VL nubwo intubation itoroshye itateganijwe [10,11].VL irasabwa cyane kandi ikoreshwa nkigice cyumurongo wambere muburyo busanzwe bwa intubation [10,13,23,24], kandi hari ibimenyetso bishyigikira inyungu zayo kubarwayi bafite inzira zo mu kirere zigoye [25].

Ntabwo byumvikana cyane ku ngaruka za VL na DL ku ngaruka z’ubukungu bw’ubuzima ku barwayi barimo kubagwa batoranijwe.Ubushakashatsi bwakozwe na Alsumali na bagenzi be bakoresheje icyitegererezo cy’ibiti by’icyitegererezo cyerekanye ko VL ifitanye isano no kugabanya ibintu bibi kandi ko hari amadorari 3429 yazigamye kuri buri kintu kibi cyirinze mu cyumba cyo gukoreramo [26].Ubundi bushakashatsi bwa retrospective cohort bwakozwe na Moucharite na bagenzi be bwerekanye intubations zigoye kandi zananiranye nazo zijyanye nigiciro kinini cy’abarwayi ndetse na LOS ndende [27].Intego yubu bushakashatsi yari iyo gusesengura amakuru nyayo yaturutse muri Minisiteri y’Ubuzima Yita ku Buzima, bingana na 25% by’abinjira mu bitaro by’Amerika muri Amerika, kugira ngo icyuho kibe.Ingano nini yintangarugero itanga imbaraga zihagije zo kwiga ibibazo bidasanzwe tracheal intubation ifitanye isano.Kubera ko uburyo bugoye, ibiciro hamwe n’ibisubizo by’abarwayi biteganijwe ko bitandukanye cyane mu matsinda ya MDC, isesengura ryashimangiwe no gukora igereranya ku rwego rwa MDC.Amatsinda ya MDC yashizweho mugabanya ibice byose bishoboka kwisuzumisha mubice 25 byihariye byo kwisuzumisha.Kwipimisha muri buri MDC bihuye na sisitemu imwe cyangwa etiologiya kandi muri rusange bifitanye isano nubuvuzi bwihariye.Ubuvuzi bwa Clinical busanzwe butegurwa hakurikijwe sisitemu yibasiwe.Gukoresha amatsinda ya MDC byadufashije kugabanya umubare wuburyo bwo kubaga burimo tutagabanije gusesengura ubwoko bwihariye bwo kubaga.

Iyo ugereranije ibiranga abarwayi nibitaro hagati yabarwayi bakira DL cyangwa VL, twabonye itandukaniro ryinshi.Abarwayi bari bato, abagabo cyangwa Caucase ni bo bakiriye VL, naho abarwayi bo mu bitaro byigisha cyangwa mu turere two mu burengerazuba bwo hagati cyangwa mu Burengerazuba bwa Amerika bakunze kubona VL.Itandukaniro ryo gukoresha VL rishobora kuba ritagaragaza gusa itandukaniro ryo gukenera gukoresha VL ku barwayi runaka, ariko rishobora no kwerekana uburyo bwihuse bwo gukoresha ikoranabuhanga rishya n'amahugurwa bitewe n'ubushobozi bwo kwigisha ibitaro n'aho biherereye.Mu buryo nk'ubwo, itandukaniro mu mikoreshereze ya VL mu moko rishobora kwerekana itandukaniro mubyo umuntu akunda n'ibiranga ibitaro, harimo ingano, akarere n'ubushobozi bwo kwigisha.Usibye kugenzura ibintu bitandukanye biranga abarwayi n’ibitaro, isesengura ryinshi ryagenzuwe mugihe cya anesteziya, ikimenyetso gishobora kuba ingorabahizi.

Ubu bushakashatsi bwerekanye ko ubukungu bwifashe neza muri VL ugereranije na DL ku barwayi barimo kubagwa batoranijwe mu bitaro by’abarwayi kandi byemeza ibya Alsumalin'abandi.[26].Impuzandengo y'ibiciro by'abarwayi bose bari hasi cyane ku barwayi bavuwe na VL kurusha DL mu munani kuri icumi ya MDC.Ikiguzi cyo kuzigama kuri buri gikorwa cy’abarwayi cyatangiraga kuva $ 1144 kugeza $ 5891, bitewe nitsinda rya MDC.Ibiciro byagabanutse birashobora kwerekana umusaruro w’abarwayi, kuko VL nayo yari ifitanye isano n’ibitaro bigufi bya LOS, aho impuzandengo yo kuguma yagabanutse kugeza ku munsi urenze 1 mu gice cy’amatsinda ya MDC.Ikigaragara ni uko amahirwe yo kwinjira nyuma yo gutangira kwinjira muri ICU yari make cyane kuri VL kurusha DL mumatsinda icumi ya MDC.VL yanahujwe no kuba bishoboka cyane ko ibibazo byumutima nimiyoboro y'amaraso hamwe n'ubuhumekero bitandatu na bitatu mumatsinda icumi ya MDC.Muri rusange, iri sesengura ryerekana inyungu rusange yo gukoresha VL muburyo bwo kubaga hakoreshejwe uburyo bwo kubaga abarwayi, bigaragarira mu kugabanya ibiciro, LOS ngufi kandi bikagabanya amahirwe yo kuba ingorane no kwinjira muri ICU nyuma yo gutangira.

Twese tuzi aho ubushobozi bwacu bugarukira.Icya mbere, ni ugusubiramo amakuru akoreshwa mubikorwa byubuyobozi, kwishyuza no kwishyura.Nta kode ya CPT / HCPCS cyangwa ICD-10 yo kubaga kugirango tumenye neza uburyo bwa intubation bwakoreshejwe mugihe cyose cyo kubaga.Ijambo ryibanze ryishakisha rishobora kuba ryananiwe kumenya abarwayi bose kubera kutuzuza urutonde rwijambo ryibanze cyangwa ibitaro bidatanga raporo yamagambo bitewe nubwishyu bwuzuye mubikorwa bisanzwe byubuvuzi.Muri ubu bushakashatsi, twasanze inzira za DL zitaragaragaye cyane.Kwinjiza abarwayi mu itsinda rya DL umurongo wo kwishyuriraho ibitaro utagaragaje ubwoko bwa laryngoscopi ushobora kuba waratumye habaho kutita ku barwayi bamwe na bamwe bakira VL nka DL, bikavamo itsinda rya DL ritandukanye kandi bigatuma itandukaniro riri hagati y’amatsinda bigorana kubimenya.Twakoze isesengura ryimikorere dukoresheje imanza zemewe za VL na DL kugirango dukemure iyi mbogamizi, byavuyemo ibisubizo bisa.Birashoboka kandi ko abarwayi bamwe bafite ibibazo byumuyaga byiganje bishobora kugirira akamaro VL mubyukuri bakiriye DL, birashoboka ko byongera amahirwe, kimwe nibitandukaniro bibaho, byikibazo nyuma yibikorwa mumatsinda ya DL.Icy'ingenzi, isesengura ryububiko bwubutegetsi rishingiye ku mibare ifatika ku isi, hamwe n’abarwayi bahabwa ubuvuzi bw’ibitaro.Kubwibyo, kuba hasi yibibazo biterwa nabarwayi barwaye VL byagaragaye muri ubu bushakashatsi byerekana imiterere-nyayo ibaho mugihe cyo kubaga, tutitaye ko VL igomba gukoreshwa mubibazo byihariye by’abarwayi bafite ibibazo by’imyuka ihumeka.Byongeye kandi, nubwo twatandukanije abarwayi nitsinda rya MDC, buri tsinda rya MDC ririmo uburyo bwinshi bwibikorwa bishobora kugira ingaruka ku musaruro w’abarwayi, igihe cyo kumara n’ibiciro.Isesengura ryacu ryibanze ku barwayi basanzwe muri buri tsinda rya MDC, bitandukanye na sisitemu yihariye, aho hashobora kubaho impinduka zikomeye mubisubizo byubuzima.Inyigisho z'ejo hazaza zishobora gutsinda iyi mbogamizi.Inyigisho z'ejo hazaza zishobora kandi kumenya igihe n'impamvu VL yatoranijwe hejuru ya DL, harimo inshuro VL iboneka kubanya anesthetiste gukoresha.

Indi mbogamizi ni uko ububikoshingiro butarimo amakuru yerekeye ibintu bimwe na bimwe byuburyo bwa intubation ubwabyo, nkumubare wabagerageje, igihe cyo gutangira, cyangwa igipimo cyambere cyo gutsinda, gishobora kugira ingaruka kubisubizo byabarwayi.Kugerageza gukoresha kodegisi ya ICD-10 kugirango hamenyekane ibyangiritse byoroheje n amenyo yangiritse hamwe nubushakashatsi bugoye bwasanze umubare muto cyane wamakuru yatangajwe, ashobora guterwa no gufata no kwandikisha bituzuye (amakuru aterekanwa).Ububikoshingiro ntibwigeze bugaragaza ingaruka z’abarwayi ziterwa no kwandura kwa tracheal bigoye nko kurwego rwo gufungura umunwa, icyiciro cya Mallampati, intera ya tromomental no kugenda ijosi, ibyo bikaba bishobora kugira ingaruka kuri gahunda ya intubation ya muganga kandi bikagira ingaruka ku barwayi.Ububiko bwubutegetsi kandi ntabwo bwarimo amakuru yubuvuzi bw’abarwayi nko gushyira mu byiciro ASA, gukora isuzuma ry’ibintu by’ubuvuzi by’abarwayi bitarenze isesengura ryakozwe.Hanyuma, gusuzuma ingaruka ndende zuburyo bwa intubation zirenze iyi nyigo.Ingaruka za VL na DL kumikoreshereze yigihe kirekire yubuzima bw’abarwayi cyangwa ubuzima bwiza, buterwa no kwangirika kwubwonko cyangwa kwandura umusonga watewe na intubation igoye, birakwiye ubushakashatsi.

Umwanzuro

Mu gusoza, iri sesengura ryerekana ko hashobora kubaho iterambere mubisubizo byubukungu bwubuzima ukoresheje VL ugereranije na DL mumatsinda menshi ya MDC.Nubwo tudashobora gufata umwanzuro utomoye kugeza igihe ubushakashatsi buteganijwe burangiye, ibisubizo byerekana ko VL ishobora guhitamo DL kubikorwa byo kubaga byatoranijwe muburyo bwo kuvura.Iri sesengura ryerekana kandi ko hakenewe inyandiko zikwiye zerekana uburyo bwa laryngoscopi, kubera ko hafi 10% yimanza zerekanwe muburyo bwo kwishyuza niba VL cyangwa DL yarakoreshejwe, kandi munsi ya 0.15% byagaragaye igihe DL yakoreshejwe.Turasaba ko abaganga na sisitemu ya EMR bongera imbaraga zabo mukwandika amakuru ya laryngoscopi, harimo uburyo, umubare wabagerageje intubation hamwe nubutsinzi - kunanirwa kugerageza bwa mbere intubation kugirango byorohereze ubushakashatsi buzaza ugereranije nuburyo bwa laryngoscopi.

Ingingo z'incamake

  • Nubwo hari inyungu zifatika zamavuriro ya videwo laryngoscopi (VL) hejuru ya laryngoscopi (DL) itaziguye mu cyumba cyo gukoreramo, ibyavuye mu bukungu bw’ubuzima bwa VL na DL ntabwo byasobanuwe.
  • Ubu bushakashatsi bwisubireho bwagereranije amafaranga yose y’abarwayi, igihe cyo kumara ibitaro (LOS), ishami ryita ku barwayi bakomeye (ICU) n’igipimo cy’ingutu hagati y’abarwayi bakiriye VL na DL mu cyumba cyo kubaga kugira ngo babagwa.
  • Isesengura ryagenzuwe ku itandukaniro ry’imibare y’abarwayi n’ibiranga ivuriro, hamwe n’ibiranga ibitaro hamwe nuburyo bwo kugereranya abarwayi mu byiciro bimwe byo gusuzuma (MDC).
  • Muri cohort yahinduwe, ibiciro byabarwayi kuri VL byari munsi cyane ya DL mumatsinda umunani kuri icumi ya MDC, hamwe nigiciro cyatandukanijwe hagati y $ 1144 kugeza $ 5891 hagati yitsinda rya VL na DL.
  • Ugereranije nitsinda rya DL, impuzandengo ya LOS yari hasi cyane mumatsinda ya VL mumatsinda umunani kuri icumi ya MDC, hamwe nitsinda ritanu rya MDC hamwe no kugabanya umunsi 1 LOS kubarwayi bo mumatsinda ya VL.
  • Amahirwe yo kwinjira nyuma yo gutangira ICU yari make cyane mumatsinda icumi yose ya MDC, kubitsinda VL nitsinda rya DL.
  • Igipimo cyingorabahizi zanduye ibihaha, ibibazo byumutima nimiyoboro yubuhumekero, byari hasi mumatsinda ya VL hamwe na DL mumatsinda menshi ya MDC.
  • Muri rusange, ubu bushakashatsi bwerekana ko umusaruro w’ubukungu w’ubuzima wateye imbere ku barwayi bakira VL na DL mu gihe cyo kubaga abarwayi, byerekana inyungu zo gukoresha VL mu buryo bwo kubaga abantu batoranijwe.
  • Isesengura rishoboka ryo kugereranya ibyavuye mu bukungu ku barwayi bakira VL na DL birakenewe kugira ngo hemezwe ibyavuye muri ubu bushakashatsi.

Amakuru yinyongera

Kureba amakuru yinyongera aherekeza iyi mpapuro sura urubuga rwikinyamakuru kuri:www.futuremedicine.com/doi/suppl/10.2217/cer-2021-0068

Umusanzu w'abanditsi

Abanditsi bose batanze umusanzu munini wo kwiga gusama no gushushanya, gushaka abakozi no gushaka amakuru no / cyangwa gusesengura amakuru no gusobanura (J Zhang, W Jiang na F Urdaneta);yagize uruhare mu gutegura inyandiko yandikishijwe intoki (J Zhang) na / cyangwa kuyisubiramo cyane kubintu byingenzi byubwenge (W Jiang, F Urdaneta);yatanze icyemezo cyanyuma cyandikishijwe intoki cyanyuma cyashyizwe ahagaragara (J Zhang, W Jiang, F Urdaneta);kandi wemere kubazwa ibintu byose byakazi (J Zhang, W Jiang na F Urdaneta).

Gushimira

Abanditsi barashimira T Zahabu (Itumanaho rya Zahabu Bioscience) ubufasha mu gutanga inkunga yo kwandika kwa muganga na M Thapa (Medtronic) gutanga inkunga yo guhindura / gutunganya.

Inyungu & guhatanira inyungu gutangaza

J Zhang na W Jiang bavuga akazi hamwe na Medtronic;F Urdaneta ni umwe mu bagize Inama Ngishwanama ku buvuzi bwa Vyaire akaba n'umujyanama wa Medtronic kandi ahabwa icyubahiro cya disikuru kuri bombi.Abanditsi nta bundi bufatanye bafite cyangwa uruhare rw’amafaranga n’umuryango uwo ariwo wose cyangwa ikigo gifite inyungu z’amafaranga cyangwa amakimbirane y’amafaranga ku ngingo cyangwa ibikoresho byaganiriweho mu nyandiko yandikishijwe intoki usibye ibyatangajwe.

T Zahabu, (Zahabu ya Bioscience Itumanaho) yatanze inkunga yo kwandika kwa muganga naho M Thapa (Medtronic) itanga inkunga yo guhindura / gutunganya, byombi byatewe inkunga na Medtronic.

Imyitwarire yubushakashatsi

Abanditsi bavuga ko icyemezo cy’inama y’isuzumamikorere cyasonewe kubera ko amakuru yasesenguwe atamenyekanye kandi ubushakashatsi ntibwerekeranye n’amasomo y’abantu (45 CFR § 46.0001 (b) (4)).Ubushakashatsi bwubahirije amahame yavuzwe mu Itangazo rya Helsinki hamwe n’itegeko ry’ubwishingizi bw’ubuzima bwita ku buzima (HIPAA) ku iperereza ryakozwe n'abantu.

Itangazo ryo gusangira amakuru

Amakuru yubu bushakashatsi yakoreshejwe muburenganzira kandi arashobora kuboneka muri Premier Inc.

Fungura kwinjira

Aka kazi gatangiwe uruhushya muri Attribution-Non-Non-Commercial-NoDerivatives 4.0 Uruhushya rwoherejwe hanze.Kureba kopi yuru ruhushya, surahttp://creativecommons.org/licenses/by-nc-nd/4.0/

 


Igihe cyo kohereza: 06-09-22