心脏手术患者术后ICU再次插管：是否比手术室第一次插管困难？
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Reintubation in the ICU following cardiac surgery: is it more difficult than first-time intubation in the operating room?A prospective observational study
背景与目的
心脏手术后，患者的气管导管通常被拔除；然而2%至13%的心脏手术患者需要在ICU重新插管。本研究旨在比较心脏手术后ICU再次插管(如果需要)与手术室内首次插管的困难程度。
方 法
我们设计了一项前瞻性、观察性研究。经过当地伦理委员会批准，历时44个月，前瞻性收集了所有在手术室（西班牙圣地亚哥临床医院）使用直接喉镜插管，以及术后在ICU需要重新插管的心脏手术患者。主要结果是比较手术室和ICU的首次插管成功率。次要结果是比较插管的技术难度(改良Cormack-Lehane声门图、操作者报告的插管困难、直接喉镜插管需要辅助)和并发症发生率。
结 果
共有122名心脏外科患者需要在ICU重新插管。再次插管的首次成功率低于手术室内插管(88.5 vs 97.6%，P=0.0048)。ICU重新插管与 Cormack–Lehane分级IIb、III或IV级的较高发生率相关(34.5vs.10.7%，P<0.0001)，且中度或重度困难插管的发生率较高(17.2 vs 6.5%，P=0.0001)，直接喉镜插管时更需要辅助(20.5 vs 10.7%，P=0.005)。ICU内重新插管的并发症更常见(39.3 vs 5.7%，P<0.0001)。
结 论
与手术室内插管相比，心脏手术患者ICU重新插管技术难度更大，并发症发生率更高。
原始文献摘要
Taboada M, Rey R, Martínez S, et al. Reintubation in the ICU following cardiac surgery: is it more difficult than first-time intubation in the operating room?A prospective observational study.[J]. Eur J Anaesthesiol. 2020 Jan;37(1):25-30. doi: 10.1097/EJA.0000000000001019.
BACKGROUND After cardiac surgery, a patient’s trachea is usually extubated; however, 2 to 13% of cardiac surgery patients require reintubation in the ICU.
OBJECTIVE The objective of this study was to compare the initial intubation in the cardiac operating room with reintubation (if required) in the ICU following cardiac surgery.
DESIGN A prospective, observational study.
SETTING Department of Anesthesiology and Intensive Care Medicine, Clinical Hospital of Santiago, Spain.
PATIENTS With approval of the local ethics committee, over a 44-month period, we prospectively enrolled all cardiac surgical patients who were intubated in the operating room using direct laryngoscopy, and who required reintubation later in the ICU.
MAIN OUTCOME MEASURES The primary endpoint was to compare first-time success rates for intubation in the oper-ating room and ICU. Secondary endpoints were to compare the technical difficulties of intubation (modified Cormack–Lehane glottic view, operator-reported difficulty of intubation,need for support devices for direct laryngoscopy) and the incidence of complications.
RESULTS A total of 122 cardiac surgical patients required reintubation in the ICU. Reintubation was associated with a lower first-timesuccess ratethan in theoperating room(88.5vs. 97.6%, P=0.0048). Reintubation in the ICU was associated with a higher incidence of Cormack–Lehane grades IIb, III or IV views (34.5 vs. 10.7%, P<0.0001), a higher incidence of moderate or difficult intubation (17.2 vs. 6.5%,P=0.0001) and a greater need for additional support during direct laryngoscopy (20.5 vs. 10.7%, P=0.005). Complications were more common during reintubations in the ICU(39.3 vs. 5.7%, P<0.0001).
CONCLUSION Compared with intubations in the operating room, reintubation of cardiac surgical patients in the ICU was associated with more technical difficulties and a higher incidence of complications.
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翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙