SummaryBackgroundDifferent sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta‐analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and a lower risk of arterial oxygen desaturation.MethodsWe searched for randomised controlled trials of patients undergoing awake tracheal intubation for any indication and reporting: overall tracheal intubation success rate; tracheal intubation time; incidence of arterial oxygen desaturation; and other related outcomes. We performed a frequentist network meta‐analysis for these outcomes if two or more sedation regimens were compared between included trials. We also performed a sensitivity analysis excluding trials with a high risk of bias.ResultsIn total, 48 studies with 2837 patients comparing 33 different regimens were included. Comparing overall awake tracheal intubation success rates (38 studies, 2139 patients), there was no evidence suggesting that any individual sedation regimen was superior. Comparing times to successful tracheal intubation (1745 patients, 24 studies), any sedation strategy was superior to placebo. When we excluded trials with a high risk of bias, we found no evidence of a difference between any interventions for time to successful tracheal intubation. Thirty‐one studies (1753 patients) suggested that dexmedetomidine and magnesium sulphate were associated with a reduced risk of arterial oxygen desaturation compared with other interventions, but excluding trials with a high risk of bias suggested no relevant differences between interventions. The quality of evidence for each of our outcomes was low.ConclusionsTo maximise effective and safe awake tracheal intubation, optimising oxygenation, topical airway anaesthesia and procedural performance may have more impact than any given sedation regimen.

中文翻译：

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清醒气管插管镇静：系统评价和网状荟萃分析


摘要背景不同的镇静方案已被用于促进清醒气管插管，但证据尚未得到有力的综合，特别是在临床重要结局方面。我们进行了系统评价和网状meta分析，以确定最有可能与气管插管成功、插管成功时间更短和动脉氧饱和度下降风险最低相关的镇静技术。方法我们检索了接受清醒气管插管患者的随机对照试验，以寻找任何适应症和报告：总体气管插管成功率;气管插管时间;动脉血氧饱和度下降的发生率;和其他相关结局。如果比较纳入试验之间的两种或多种镇静方案，我们对这些结局进行了频率网状meta分析。我们还进行了敏感性分析，排除了具有高偏倚风险的试验。结果共纳入 48 项研究，涉及 2837 名患者，比较了 33 种不同的方案。比较总体清醒气管插管成功率 （38 项研究，2139 名患者），没有证据表明任何个体镇静方案更好。与成功气管插管的时间（1745 名患者，24 项研究）相比，任何镇静策略都优于安慰剂。当我们排除具有高偏倚风险的试验时，我们没有发现任何干预措施在气管插管成功时间方面存在差异。 31 项研究（1753 名患者）表明，与其他干预措施相比，右美托咪定和硫酸镁与动脉血氧饱和度下降风险降低相关，但排除具有高偏倚风险的试验表明干预措施之间没有相关差异。我们每个结局的证据质量都很低。结论为了最大限度地有效和安全的清醒气管插管，优化氧合、局部气道麻醉和操作性能可能比任何给定的镇静方案产生更大的影响。