СРАВНЕНИЕ РАЗЛИЧНЫХ ВИДОВ ИНТУБАЦИИ ВО ВРЕМЯ РЕАНИМАЦИИ ПАЦИЕНТОВ С COVID-19 БРИГАДОЙ ПАРАМЕДИКОВ В СРЕДСТВАХ ИНДИВИДУАЛЬНОЙ ЗАЩИТЫ
Аннотация
Эндотрахеальная интубация – один из основных методов контроля дыхательных путей во время сердечно-лёгочной реанимации. В эпоху пандемии SARS-CoV-2 медицинский персонал может столкнуться с необходимостью реанимировать инфицированного пациента. Цель. Сравнить три метода интубации трахеи при планируемой реанимации взрослых пациентов с COVID-19, выполняемой парамедиками в средствах индивидуальной защиты (СИЗ) при процедурах генерации аэрозоля (ПГА). Материал и методы. В многоцентровом проспективном рандомизированном перекрестном имитационном исследовании участвовали 32 медработника. Участники в СИЗ при ПГА проводили интубации трахеи с помощью ларингоскопов MAC Macintosh, Airtraq и McGrath у пациента с подозрением на COVID-19 в двух сценариях реанимации. Сценарий A – без сдавливания грудной клетки, сценарий Б – с непрерывными компрессиями грудной клетки. Первичным результатом было время интубации. Результаты. При сценарии A время интубации для соответствующих устройств составило 35 с (IQR: 29-46) против 44 с (IQR: 35-67) против 49 (IQR: 34-72) (p=0,003). Общая эффективность каждого метода интубации составила 100%; однако эффективность первой попытки интубации была самой высокой для McGrath MAC (90,6%), за которым следовали Macintosh (68,1%) и Airtraq 62,5%) (p<0,001). В сценарии B результаты с McGrath MAC были значительно лучше, чем у Macintosh и Airtraq (p<0,05) по всем анализируемым переменным. Выводы. Видеоларингоскоп McGrath MAC предлагает лучшие условия интубации по сравнению с ларингоскопом Macintosh или Airtraq при реанимации взрослых пациентов с COVID-19.
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