Article record

新生儿和婴儿视频喉镜与首次气管插管成功率：一项使用日本小儿麻醉困难气道（J-PEDIA）登记处的回顾性队列研究。

Videolaryngoscopy and first-attempt tracheal intubation success in neonates and infants: a retrospective cohort study using the Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) registry.

临床研究咽喉科IF 10.8Q1

文献信息

PMID	42778452
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Tomoharu Ukiya 查看其他 6 位作者 Fumio Watanabe；Megumi Okuyama；Yasuma Kobayashi；Yu Kaiho；Takahiro Imaizumi；Taiki Kojima
作者单位	Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan. 查看其他 6 条单位信息 Department of Anesthesiology, Aichi Children's Health and Medical Center, Ōbu, Japan.；Department of Anesthesiology, Institute of Science Tokyo Hospital, Tokyo, Japan.；Department of Anesthesiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan.；Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.；Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan.；Department of Anesthesiology, Aichi Children's Health and Medical Center, Ōbu, Japan; Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: kojima.taiki@saitama-pho.jp.
期刊	British journal of anaesthesia
SCI 分区	Q1
IF	10.8
研究类型	临床研究 · 临床
所属专科	咽喉科

中文摘要

背景： 首次气管插管成功对新生儿和婴儿至关重要。尽管视频喉镜（VL）被推荐用于新生儿和婴儿插管，但其在真实世界实践中的有效性仍不确定。我们使用多中心气道登记处评估了在新生儿和婴儿初始气管插管尝试中使用VL与首次气管插管成功之间的关联。
方法： 这项回顾性队列研究使用了日本小儿麻醉困难气道（J-PEDIA）登记处的数据，收集时间为2022年6月至2025年2月。主要结局是首次气管插管成功。次要结局包括声门开放百分比评分、呼吸不良事件和血红蛋白氧饱和度下降。应用基于倾向评分的逆概率治疗加权来调整潜在混杂因素。
结果： 总体分析了3250例次操作。经过逆概率治疗加权调整后，VL与首次成功率低于直接喉镜相关（调整风险比0.89，95%置信区间[CI] 0.83-0.96，P=0.001）。VL还与更高的声门开放百分比评分相关（β 17.8，95% CI 9.5-26.1，P<0.001），但增加了饱和度下降风险（调整风险比2.18，95% CI 1.57-2.79，P<0.001）。两组呼吸不良事件发生率相似（调整风险比-0.09，95% CI -0.012至0.0097，P=0.86）。
结论： 与直接喉镜相比，使用VL与较低的首次气管插管成功率和较高的饱和度下降风险相关。这些发现提示在非标准化的真实世界实践中存在效力-效果差距。可能需要结构化的VL实施和针对性培训，才能将改善的可视化转化为成功的首次气管插管。
临床试验注册： jRCT；注册号：1040250033。

英文摘要

BACKGROUND: First-attempt tracheal intubation success is critical in neonates and infants. Although videolaryngoscopy (VL) is recommended for neonatal and infant intubation, uncertainty remains regarding its effectiveness in real-world practice. We evaluated the association between use of VL for the initial tracheal intubation attempt and first-attempt tracheal intubation success in neonates and infants using a multicentre airway registry.
METHODS: This retrospective cohort study used data from the Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) registry, collected between June 2022 and February 2025. The primary outcome was first-attempt tracheal intubation success. Secondary outcomes included the percentage of glottic opening score, respiratory adverse events, and haemoglobin oxygen desaturation. Propensity score-based inverse probability of treatment weighting was applied to adjust for potential confounders.
RESULTS: Overall, 3250 encounters were analysed. After inverse probability of treatment weighting adjustment, VL was associated with a lower probability of first-attempt success than direct laryngoscopy (adjusted risk ratio 0.89, 95% confidence interval [CI] 0.83-0.96, P=0.001). VL was also associated with higher percentage of glottic opening scores (β 17.8, 95% CI 9.5-26.1, P<0.001), but increased risk of desaturation (adjusted risk ratio 2.18, 95% CI 1.57-2.79, P<0.001). The incidence of respiratory adverse events was similar between the groups (adjusted risk ratio -0.09, 95% CI -0.012 to 0.0097, P=0.86).
CONCLUSIONS: VL use was associated with lower first-attempt tracheal intubation success and a higher risk of desaturation compared with direct laryngoscopy. These findings suggest an efficacy-effectiveness gap in non-standardised real-world practice. Structured VL implementation and targeted training might be required to translate improved visualisation into successful first-attempt tracheal intubation.
CLINICAL TRIAL REGISTRATION: jRCT; registration number: 1040250033.