1
|
Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H, Kehl F, Loop T, Raymondos K, Sujatta S, Timmermann A, Zwißler B, Noppens R. [Recommendations of the new S1 guidelines on airway management]. DIE ANAESTHESIOLOGIE 2024; 73:379-384. [PMID: 38829521 DOI: 10.1007/s00101-024-01414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 06/05/2024]
Abstract
The German guidelines for airway management aim to optimize the care of patients undergoing anesthesia or intensive care. The preanesthesia evaluation is an important component for detection of anatomical and physiological indications for difficult mask ventilation and intubation. If predictors for a difficult or impossible mask ventilation and/or endotracheal intubation are present the airway should be secured while maintaining spontaneous breathing. In an unexpectedly difficult intubation, attempts to secure the airway should be limited to two with each method used. A video laryngoscope is recommended after an unsuccessful direct laryngoscopy. Therefore, a video laryngoscope should be available at every anesthesiology workspace throughout the hospital. Securing the airway should primarily be performed with a video laryngoscope in critically ill patients and patients at risk of pulmonary aspiration. Experienced personnel should perform or supervise airway management in the intensive care unit.
Collapse
Affiliation(s)
- Tim Piepho
- Krankenhaus der Barmherzigen Brüder Trier, Abteilung für Anästhesie und Intensivmedizin, Nordallee 1, 54292, Trier, Deutschland.
| | - Marc Kriege
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Christian Byhahn
- Evangelisches Krankenhaus, Klinik für Anästhesiologie, Notfallmedizin und Schmerztherapie, Universitätsmedizin Oldenburg, Steinweg 13-17, 26122, Oldenburg, Deutschland
| | - Erol Cavus
- Anästhesie Partner Holstein, Dahlienstr. 15, 23795, Bad Segeberg, Deutschland
| | | | - Hendrik Ilper
- Abteilung für Anästhesie, Intensiv- und Rettungsmedizin, Zentrum für Schmerztherapie, BG Klinikum Hamburg gGmbH, Bergedorfer Straße 10, 21033, Hamburg, Deutschland
| | - Franz Kehl
- Klinik für Anästhesie und Intensivmedizin, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland
| | - Torsten Loop
- Universitätsklinikum Freiburg, Klinik für Anästhesiologie und Intensivmedizin, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Konstantinos Raymondos
- Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin, Carl-Neuberg-Str., 30625, Hannover, Deutschland
| | - Susanne Sujatta
- Klinikum Bayreuth GmbH, Klinik für Anästhesiologie und Operative Intensivmedizin, Preuschwitzer Str. 101, 95445, Bayreuth, Deutschland
| | - Arnd Timmermann
- Klinik für Anästhesie, Schmerztherapie, Intensiv- und Notfallmedizi, DRK Kliniken Berlin Westend und Mitte, Spandauer Damm 130, 14050, Berlin, Deutschland
| | - Bernhard Zwißler
- Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Ruediger Noppens
- Department of Anesthesia & Perioperative Medicine LHSC, University Hospital, 339 Windermere Road, N6A 5A5, London, ON, Kanada
| |
Collapse
|
2
|
Sturesson LW, Persson K, Olmstead R, Bjurström MF. Influence of airway trolley organization on efficiency and team performance: A randomized, crossover simulation study. Acta Anaesthesiol Scand 2023; 67:44-56. [PMID: 36196685 PMCID: PMC10092151 DOI: 10.1111/aas.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Failed management of unanticipated difficult airway situations contributes to significant anesthesia-related morbidity and mortality. Optimization of design and layout of difficult airway trolleys (DATs) may influence outcomes during airway emergencies. The main objective of the current study was to evaluate whether a difficult airway algorithm-based DAT with integrated cognitive aids improves efficiency and team performance in difficult airway scenarios. METHODS In a crossover design, 16 teams (anesthetist, nurse anesthetist, assistant nurse) completed two high-fidelity simulated unanticipated difficult airway scenarios. Teams used both an algorithm-based DAT and a comparison, standard DAT, in the scenarios and were randomized to order of trolley type. Outcome measures included objective efficiency parameters, team performance assessment and subjective user-ratings. Linear mixed models ANOVA, including DAT type and order of condition as main factors, was utilized for the primary analyses of the team results. RESULTS Usage of the algorithm-based DAT was associated with fewer departures from the difficult airway algorithm (p = .010), and reduced number of unnecessary drawer openings (p = .002), but no significant differences in time to retrieval of airway devices or time to first effective ventilation, compared to the standard DAT. There were no significant differences in team performance, although participants expressed strong preference for the algorithm-based DAT (all user-rated measures p < .0001). Higher percentage of female members of the team improved adherence to the difficult airway algorithm (p = .043). CONCLUSIONS Algorithm-based DATs with integrated cognitive aids may improve efficiency in difficult airway situations, compared to traditional DATs. These findings have implications for improvement of anesthetic practice.
Collapse
Affiliation(s)
- Louise W Sturesson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Karolina Persson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Richard Olmstead
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Martin F Bjurström
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden.,Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| |
Collapse
|
3
|
Tankard KA, Sharifpour M, Chang MG, Bittner EA. Design and Implementation of Airway Response Teams to Improve the Practice of Emergency Airway Management. J Clin Med 2022; 11:6336. [PMID: 36362564 PMCID: PMC9656324 DOI: 10.3390/jcm11216336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 09/11/2023] Open
Abstract
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, the practice of EAM is associated with significant morbidity and mortality. Evidence suggests that a dedicated airway response team (ART) can help mitigate the risks associated with EAM and provide a framework for airway management in acute settings. We review the risks and challenges related to EAM and describe strategies to improve patient care and outcomes via implementation of an ART.
Collapse
Affiliation(s)
- Kelly A. Tankard
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Milad Sharifpour
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA 90048, USA
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Edward A. Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
4
|
Endlich Y, Hore PJ, Baker PA, Beckmann LA, Bradley WP, Chan KLE, Chapman GA, Jephcott CGA, Kruger PS, Newton A, Roessler P. Updated guideline on equipment to manage difficult airways: Australian and New Zealand College of Anaesthetists. Anaesth Intensive Care 2022; 50:430-446. [PMID: 35722809 DOI: 10.1177/0310057x221082664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways.
Collapse
Affiliation(s)
- Yasmin Endlich
- Department of Anaesthesia and Acute Pain Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Paediatric Anaesthesia, Women's and Children's Hospital, North Adelaide, Australia.,Faculty of Anaesthesia, University of Adelaide, Adelaide, Australia
| | - Phillipa J Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
| | - Linda A Beckmann
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - William P Bradley
- Department of Anaesthesia and Perioperative Medicine, The Alfred, Melbourne, Australia.,Faculty of Anaesthesia, Monash University, Melbourne, Australia
| | - Kah L E Chan
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Gordon A Chapman
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia.,Faculty of Anaesthesia, University of Western Australia, Perth, Australia
| | | | - Peter S Kruger
- Department of Intensive Care Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Alastair Newton
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Australia.,Retrieval Services Queensland, Brisbane, Australia
| | - Peter Roessler
- Safety and Advocacy Unit, Australian and New Zealand College of Anaesthetists, Melbourne, Australia
| |
Collapse
|
5
|
Taboada M, Baluja A, Park SH, Otero P, Gude C, Bolón A, Ferreiroa E, Tubio A, Cariñena A, Caruezo V, Alvarez J, Atanassoff PG. Complications during repeated tracheal intubation in the Intensive Care Unit. A prospective, observational study comparing the first intubation and the reintubation. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:384-391. [PMID: 34353767 DOI: 10.1016/j.redare.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/02/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND GOAL OF THE STUDY The goal of the study was to compare the incidence of complications, technical difficulty of intubation and physiologic pre-intubation status between the first intubation and reintubation performed on the same patient in an ICU. MATERIALS AND METHODS The study was approved by the ethics committee of Galicia (Santiago-Lugo, code No. 2015-012). Due to the observational, noninterventional, and noninvasive design of this study, the need for written consent was waived by the ethics committee of Galicia. Patients requiring tracheal intubation and reintubation in the ICU were included in this prospective observational study. Main endpoint was to compare the incidence of complications, physiologic pre-intubation status, and the rate of technical difficulty of intubation between the first intubation and reintubation performed on the same patient in an ICU. RESULTS AND DISCUSSION 504 patients were intubated in our ICU during the study period, and 82 (16%) required reintubation. There was no difference between the first intubation and reintubation regarding number of total complication (35% vs 33%; P = ,86), hypotension (24% vs 24%; P = 1), hypoxia (26% vs 26%; P = 1), esophageal intubation (1% vs 1%; P = 1), and bronchoaspiration (2% vs 1%; P = ,86). Physiologic pre-intubation status and technical difficulty of intubation did not differ between the first intubation and reintubation. CONCLUSIONS In our ICU patients requiring tracheal reintubation, incidence of complications, physiologic pre-intubation status, and technical difficulty of intubation did not differ between the first intubation and reintubation.
Collapse
Affiliation(s)
- M Taboada
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A Baluja
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - S H Park
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - P Otero
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - C Gude
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Bolón
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ferreiroa
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Tubio
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Cariñena
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - V Caruezo
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - J Alvarez
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | |
Collapse
|
6
|
Smischney NJ, Khanna AK, Brauer E, Morrow LE, Ofoma UR, Kaufman DA, Sen A, Venkata C, Morris P, Bansal V. Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study. J Intensive Care Med 2020; 36:1466-1474. [PMID: 33000661 DOI: 10.1177/0885066620962445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known about hypoxemia surrounding endotracheal intubation in the critically ill. Thus, we sought to identify risk factors associated with peri-intubation hypoxemia and its effects' on the critically ill. METHODS Data from a multicenter, prospective, cohort study enrolling 1,033 critically ill adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 were used to identify risk factors associated with peri-intubation hypoxemia and its effects on patient outcomes. We defined hypoxemia as any pulse oximetry ≤ 88% during and up to 30 minutes following endotracheal intubation. RESULTS In the full analysis (n = 1,033), 123 (11.9%) patients experienced the primary outcome. Five risk factors independently associated with our outcome were identified on multiple logistic regression: cardiac related reason for endotracheal intubation (OR 1.67, [95% CI 1.04, 2.69]); pre-intubation noninvasive ventilation (OR 1.66, [95% CI 1.09, 2.54]); emergency intubation (OR 1.65, [95% CI 1.06, 2.55]); moderate-severe difficult bag-mask ventilation (OR 2.68, [95% CI 1.72, 4.19]); and crystalloid administration within the preceding 24 hours (OR 1.24, [95% CI 1.07, 1.45]; per liter up to 4 liters). Higher baseline SpO2 was found to be protective (OR 0.93, [95% CI 0.91, 0.96]; per percent up to 97%). Consistent results were seen in a separate analysis on only stable patients (n = 921, 93 [10.1%]) (those without baseline hypoxemia ≤ 88%). Peri-intubation hypoxemia was associated with in-hospital mortality (OR 2.40, [95% CI 1.33, 4.31]; stable patients: OR 2.67, [95% CI 1.38, 5.17]) but not ICU length of stay (point estimate 0.9 days, [95% CI -1.0, 2.8 days]; stable patients: point estimate 1.5 days, [95% CI -0.4, 3.4 days]) after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline SPO2. CONCLUSIONS Patients with pre-existing noninvasive ventilation and volume loading who were intubated emergently in the setting of hemodynamic compromise with bag-mask ventilation described as moderate-severe were at increased risk for peri-intubation hypoxemia. Higher baseline oxygenation was found to be protective against peri-intubation hypoxemia. Peri-intubation hypoxemia was associated with in-hospital mortality but not ICU length of stay. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101.
Collapse
Affiliation(s)
- Nathan J Smischney
- Department of Anesthesiology and Perioperative Medicine, 4352Mayo Clinic, Rochester, MN, USA.,HEModynamic and AIRway Management (HEMAIR) Study Group Mayo Clinic, Rochester, MN, USA
| | - Ashish K Khanna
- Outcomes Research Consortium, 2569Cleveland Clinic, Cleveland, OH, USA.,Department of Anesthesia, Section on Critical Care Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Ernesto Brauer
- Department of Critical Care Medicine, Aurora Health Care, Milwaukee, WI, USA
| | - Lee E Morrow
- Department of Critical Care Medicine, Creighton University, Omaha, NE, USA
| | - Uchenna R Ofoma
- Division of Critical Care Medicine, Geisinger Health System, Danville, PA, USA
| | - David A Kaufman
- Section of Pulmonary, Critical Care, and Sleep Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Ayan Sen
- Department of Critical Care Medicine, 4352Mayo Clinic, Jacksonville, FL, USA
| | - Chakradhar Venkata
- Department of Critical Care Medicine, 7537Mercy Hospital, St. Louis, MO, USA
| | - Peter Morris
- Department of Anesthesia and Critical Care Medicine, University of Kentucky, Lexington, KY, USA
| | - Vikas Bansal
- Department of Critical Care Medicine, 4352Mayo Clinic, Scottsdale, AZ, USA. Ofoma is now with Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA; Kaufman is now with Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY, USA
| |
Collapse
|
7
|
Gould CL, Alexander PDG, Allen CN, McGrath BA, Shelton CL. Protecting staff and patients during airway management in the COVID-19 pandemic: are intubation boxes safe? Br J Anaesth 2020; 125:e292-e293. [PMID: 32473727 PMCID: PMC7218390 DOI: 10.1016/j.bja.2020.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/25/2023] Open
|
8
|
In response to: Negative pressure hoods for COVID-19 tracheostomy: Unanswered questions and the interpretation of zero numerators. J Trauma Acute Care Surg 2020; 89:e156. [PMID: 32796439 DOI: 10.1097/ta.0000000000002914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Huda T, Alexander PDG, McGrath BA, Shelton CS. Comment on the article by Dr. T. Huda: Barrier device prototype for open tracheotomy during COVID-19 pandemic. Auris Nasus Larynx 2020; 47:711-712. [PMID: 32622668 PMCID: PMC7330581 DOI: 10.1016/j.anl.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Tuheen Huda
- Specialist Trainee in Intensive Care Medicine, Manchester University Hospital NHS Foundation Trust, Southmoor Road, Wythenshawe M23 9LT, UK.
| | - Peter D G Alexander
- Consultant in Anaesthesia and Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Southmoor Road, Wythenshawe M23 9LT, UK
| | - Brendan A McGrath
- Honorary Senior Lecturer, Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchster, Manchester Academic Health Centre, Oxford Road, Manchester M13 9PL, UK
| | - Cliff S Shelton
- Senior Clinical Lecturer in Anaesthesia, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University Lancaster, UK
| |
Collapse
|
10
|
McGrath BA, Wallace S, Goswamy J. Laryngeal oedema associated with COVID-19 complicating airway management. Anaesthesia 2020; 75:972. [PMID: 32302417 DOI: 10.1111/anae.15092] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B A McGrath
- Manchester University NHS Foundation Trust, Manchester, UK
| | - S Wallace
- Manchester University NHS Foundation Trust, Manchester, UK
| | - J Goswamy
- Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
11
|
|
12
|
Bjurström MF, Persson K, Sturesson LW. Availability and organization of difficult airway equipment in Swedish hospitals: A national survey of anaesthesiologists. Acta Anaesthesiol Scand 2019; 63:1313-1320. [PMID: 31286467 DOI: 10.1111/aas.13448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/09/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Airway complications account for almost one third of anaesthesia-related brain damage and death. Immediate access to equipment enabling rescue airway strategies is crucial for successful management of unanticipated difficult airway situations. METHODS We conducted a nationwide survey of Swedish anaesthesiologists to analyse availability and organization of difficult airway trolleys (DATs), and multiple factors pertaining to difficult airway management, to highlight areas of potential improvement. RESULTS Six hundred and thirty-nine anaesthesiologists completed the 14-item survey. Whereas DATs were almost ubiquitous (95%) in main operating departments of hospitals, prevalence was low in remote anaesthetizing locations (20.3%) and electroconvulsive therapy units (26.6%). Approximately 60% of emergency departments had a DAT. Immediate (within 60 seconds) access to videolaryngoscopes in all units where general anaesthesia is conducted was reported by 56.8%. Almost half of anaesthesiologists reported that all DATs at their workplace were standardized. Forty-six per cent reported that the DATs were organized according to a difficult airway algorithm; almost 90% believe that such an organization can impact the outcome of a difficult airway situation positively. Only 36.2% of DATs contained second-generation supraglottic airway devices exclusively. Most Swedish anaesthesiologists use the Swedish Society of Anaesthesiology and Intensive care Medicine difficult airway algorithm, but almost one fifth prefer the Difficult Airway Society algorithm. Less than half of respondents underwent formal difficult airway training annually. CONCLUSION Our results motivate efforts to (a) increase availability of DATs in remote anaesthetizing locations, (b) increasingly standardize DATs and organize DATs according to airway algorithms, and (c) increase the frequency of difficult airway training.
Collapse
Affiliation(s)
- Martin F. Bjurström
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Lund University, Skåne University Hospital Lund Sweden
| | - Karolina Persson
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Lund University, Skåne University Hospital Lund Sweden
| | - Louise W. Sturesson
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Lund University, Skåne University Hospital Lund Sweden
| |
Collapse
|
13
|
Yamada S, Kawakami D, Ohira J, Ueta H. Airway Obstruction Caused by Mucinous Material Adherent to the Epiglottis in a Patient with a Progressive Neurological Disorder: An Unusual Case of a Condition Mimicking Acquired Laryngomalacia. Intern Med 2019; 58:2711-2714. [PMID: 31178481 PMCID: PMC6794178 DOI: 10.2169/internalmedicine.2268-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We herein report the successful management of a condition mimicking acquired laryngomalacia using conservative methods in an elderly man with a progressive neurological disorder. The patient developed stridor and was transferred to the intensive-care unit. Flexible laryngoscopy revealed a collapsed epiglottis during inspiration, as seen in acquired laryngomalacia, with mucinous material firmly adhered to the epiglottis. The stridor resolved after the removal of this material. Pathology revealed keratinized material, suggesting a collection of sputum or epithelial tissue. Thus, flexible laryngoscopy can differentiate the cause of airway obstruction and avoid unnecessary endotracheal intubation in patients with neurological disorders.
Collapse
Affiliation(s)
- Sho Yamada
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Japan
- Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Japan
| | - Daisuke Kawakami
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Japan
| | - Junichiro Ohira
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Hiroshi Ueta
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Japan
| |
Collapse
|
14
|
Denton G, Green L, Palmer M, Jones A, Quinton S, Giles S, Simmons A, Choyce A, Munnelly S, Higgins D, Perkins GD, Arora N. The provision of central venous access, transfer of critically ill patients and advanced airway management.: Are advanced critical care practitioners safe and effective? J Intensive Care Soc 2019; 20:248-254. [PMID: 31447919 PMCID: PMC6693111 DOI: 10.1177/1751143718801706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Advanced critical care practitioners are a new and growing component of the critical care multidisciplinary team in the United Kingdom. This audit considers the safety profile of advanced critical care practitioners in the provision of central venous catheterisation and transfer of ventilated critical care patients without direct supervision and supervised drug assisted intubation of critically ill patients. The audit showed that advanced critical care practitioners can perform central venous cannulation, transfer of critically ill ventilated patients and intubation with parity to published UK literature.
Collapse
Affiliation(s)
- Gavin Denton
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Lindsay Green
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Marion Palmer
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Anita Jones
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Sarah Quinton
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Simon Giles
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Andrew Simmons
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Andrew Choyce
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Sean Munnelly
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Daniel Higgins
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Gavin D Perkins
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| | - Nitin Arora
- Critical Care Unit, Heartlands Hospital, University
Hospitals, Birmingham, UK
| |
Collapse
|
15
|
Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, Moore J, Monks S, Bowler M, Bruce IA, Bateman N, Wyatt M, Russell J, Perkins R, McGrath BA. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia 2018; 73:1400-1417. [PMID: 30062783 DOI: 10.1111/anae.14307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.
Collapse
Affiliation(s)
- C Doherty
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Neal
- Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - C English
- Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Cooke
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - D Atkinson
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Bates
- Department of Anaesthesia and Intensive Care Medicine, Royal Bolton Hospital, Bolton, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Monks
- Department of Anaesthesia, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - M Bowler
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - I A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Bateman
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - J Russell
- Department of Paediatric ENT, Our Lady's Children's Hospital, Dublin, Ireland
| | - R Perkins
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
16
|
Foy KE, Mew E, Cook TM, Bower J, Knight P, Dean S, Herneman K, Marden B, Kelly FE. Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey. Anaesthesia 2018; 73:1337-1344. [PMID: 30112809 DOI: 10.1111/anae.14359] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a 'Never Event' in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre-intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was 'available' in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and 'always available' in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new 'Never Event' and has the potential to improve airway management.
Collapse
Affiliation(s)
- K E Foy
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - E Mew
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - J Bower
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - P Knight
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
| | - S Dean
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
| | - K Herneman
- Department of Anaesthesia, Southmead Hospital, Bristol, UK
| | - B Marden
- Neonatal Intensive Care Unit, Royal United Hospital, Bath, UK
| | - F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| |
Collapse
|
17
|
Ahmed A, Azim A. Difficult tracheal intubation in critically ill. J Intensive Care 2018; 6:49. [PMID: 30123510 PMCID: PMC6090786 DOI: 10.1186/s40560-018-0318-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/02/2018] [Indexed: 11/12/2022] Open
Abstract
Background Endotracheal intubation in critically ill is a high-risk procedure requiring significant expertise in airway handling as well as understanding of pathophysiology of the disease process. Main body Critically ill patients are prone for hypotension and hypoxemia in the immediate post-intubation phase due to blunting of compensatory sympathetic response. Preoxygenation without NIV is frequently suboptimal, as alveolar flooding cause loss of alveolar capillary interface in many of these patients. All these factors, along with relative fluid deficit, neuromuscular fatigue and coexistent organ dysfunction lead to physiologically difficult airway. Airway in ICU can be classified as anatomically difficult, physiologically difficult and anatomically as well as physiologically difficult. Though rapid sequence intubation is the recommended method for securing airway in these patients, other methods like delayed sequence intubation awake intubation and double setup approach can be used in specific subgroups. Further research is needed in this field to set guidelines and fine tune airway management for patients with specific organ failure or dysfunction. Conclusion Airway in ICU should be managed according to the physiological as well as the anatomical abnormalities.
Collapse
Affiliation(s)
- Armin Ahmed
- 1Department of Critical Care Medicine, King George Medical University, Lucknow, 226003 India
| | - Afzal Azim
- 2Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| |
Collapse
|
18
|
Williams C, Bennett E. How to assist in emergency tracheal intubation. Nurs Stand 2018; 33:39-42. [PMID: 29998649 DOI: 10.7748/ns.2018.e11147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Emma Bennett
- Critical care, University Hospital of Wales, Heath Park, Cardiff, Wales
| |
Collapse
|
19
|
McNiven ND, Pracy JP, McGrath BA, Robson AK. The role of Scalpel-bougie cricothyroidotomy in managing emergency Front of Neck Airway access. A review and technical update for ENT surgeons. Clin Otolaryngol 2018; 43:791-794. [PMID: 29656528 DOI: 10.1111/coa.13120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N D McNiven
- Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | - J P Pracy
- University Hospital Birmingham, Birmingham, UK
| | - B A McGrath
- Anaesthesia & Critical Care, University Hospital of South Manchester, Wythenshawe, UK
- National Tracheostomy Safety Project, Manchester, UK
| | - A K Robson
- Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Carlisle, UK
- Director of Education, ENT UK, Royal College of Surgeons of England, London, UK
| |
Collapse
|
20
|
Teaching Airway Management as Part of Continuing Professional Development in Intensive Care Medicine. Anaesth Intensive Care 2018. [DOI: 10.1177/0310057x1804600203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
21
|
|
22
|
Arulkumaran N, McLaren CS, Arulkumaran K, Philips BJ, Cecconi M. An analysis of emergency tracheal intubations in critically ill patients by critical care trainees. J Intensive Care Soc 2018; 19:180-187. [PMID: 30159008 DOI: 10.1177/1751143717749686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction We evaluated intensive care medicine trainees' practice of emergency intubations in the United Kingdom. Methods Retrospective analysis of 881 in-hospital emergency intubations over a three-year period using an online trainee logbook. Results Emergency intubations out-of-hours were less frequent than in-hours, both on weekdays and weekends. Complications occurred in 9% of cases, with no association with time of day/day of week (p = 0.860). Complications were associated with higher Cormack and Lehane grades (p=0.004) and number of intubation attempts (p < 0.001), but not American Society of Anesthesiologist grade. Capnography usage was ≥99% in all locations except in wards (85%; p = 0.001). Ward patients were the oldest (p < 0.001), had higher American Society of Anesthesiologist grades (p < 0.001) and lowest Glasgow Coma Scale (p < 0.001). Conclusions Complications of intubations are associated with higher Cormack and Lehane grades and number of attempts, but not time of day/day of week. The uptake of capnography is reassuring, although there is scope for improvement on the ward.
Collapse
Affiliation(s)
- Nishkantha Arulkumaran
- General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Charles S McLaren
- Intensive Care Medicine, Hillingdon Hospital Foundation Trust, London, UK
| | | | - Barbara J Philips
- General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Maurizio Cecconi
- General Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
23
|
Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2017; 120:323-352. [PMID: 29406182 DOI: 10.1016/j.bja.2017.10.021] [Citation(s) in RCA: 437] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022] Open
Abstract
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.
Collapse
Affiliation(s)
- A Higgs
- Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK(8).
| | - B A McGrath
- Anaesthesia and Intensive Care Medicine, University Hospital South Manchester, Manchester, UK(9)
| | - C Goddard
- Anaesthesia & Intensive Care Medicine, Southport and Ormskirk Hospitals NHS Trust, Southport, UK(8)
| | - J Rangasami
- Anaesthesia & Intensive Care Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK(8)
| | - G Suntharalingam
- Intensive Care Medicine and Anaesthesia, London North West Healthcare NHS Trust, London, UK(10)
| | - R Gale
- Anaesthesia & Intensive Care Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK(11)
| | - T M Cook
- Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK(12)
| | | | | | | | | |
Collapse
|
24
|
Asai T. Airway management inside and outside operating rooms-circumstances are quite different. Br J Anaesth 2017; 120:207-209. [PMID: 29406169 DOI: 10.1016/j.bja.2017.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- T Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Centre, Koshigaya, Japan.
| |
Collapse
|
25
|
Varvinskiy A, Hinde T. 21st Annual Scientific Meeting of the Difficult Airway Society: lessons learned and glimpses of the future. Br J Anaesth 2017; 119:345-347. [DOI: 10.1093/bja/aex194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Scheeren TWL, Belda FJ, Perel A. The oxygen reserve index (ORI): a new tool to monitor oxygen therapy. J Clin Monit Comput 2017; 32:379-389. [PMID: 28791567 PMCID: PMC5943373 DOI: 10.1007/s10877-017-0049-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/17/2017] [Indexed: 12/19/2022]
Abstract
Supplemental oxygen is administered in the vast majority of patients in the perioperative setting and in the intensive care unit to prevent the potentially deleterious effects of hypoxia. On the other hand, the administration of high concentrations of oxygen may induce hyperoxia that may also be associated with significant complications. Oxygen therapy should therefore be precisely titrated and accurately monitored. Although pulse oximetry has become an indispensable monitoring technology to detect hypoxemia, its value in assessing the oxygenation status beyond the range of maximal arterial oxygen saturation (SpO2 ≥97%) is very limited. In this hyperoxic range, we need to rely on blood gas analysis, which is intermittent, invasive and sometimes delayed. The oxygen reserve index (ORI) is a new continuous non-invasive variable that is provided by the new generation of pulse oximeters that use multi-wavelength pulse co-oximetry. The ORI is a dimensionless index that reflects oxygenation in the moderate hyperoxic range (PaO2 100-200 mmHg). The ORI may provide an early alarm when oxygenation deteriorates well before any changes in SpO2 occur, may reflect the response to oxygen administration (e.g., pre-oxygenation), and may facilitate oxygen titration and prevent unintended hyperoxia. In this review we describe this new variable, summarize available data and preliminary experience, and discuss its potential clinical utilities in the perioperative and intensive care settings.
Collapse
Affiliation(s)
- T W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - F J Belda
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - A Perel
- Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
27
|
|
28
|
Cook T, Woodall N, Frerk C. A national survey of the impact of NAP4 on airway management practice in United Kingdom hospitals: closing the safety gap in anaesthesia, intensive care and the emergency department. Br J Anaesth 2016; 117:182-90. [DOI: 10.1093/bja/aew177] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/17/2022] Open
|