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Ward PA, McNarry AF. Maximising the benefit of new technologies in airway management. Indian J Anaesth 2024; 68:412-414. [PMID: 38764956 PMCID: PMC11100643 DOI: 10.4103/ija.ija_337_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- Patrick A. Ward
- Consultant Anaesthetist NHS Lothian, Department of Anaesthesia St John's Hospital, Howden, Livingston, United Kingdom
| | - Alistair F. McNarry
- Consultant Anaesthetist NHS Lothian, Department of Anaesthesia St John's Hospital, Howden, Livingston, United Kingdom
- Department of Anaesthesia, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
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2
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Frances R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00022-2. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Teresa López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Frances
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC)
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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3
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Bringier R, Arrigoni A, Muret J, Dro A, Gayat E, Vallée F, Arrigoni Marocco S. An integrated environmental, economic, and clinician satisfaction comparison between single-use and reusable flexible bronchoscopes for tracheal intubation. Br J Anaesth 2023:S0007-0912(23)00119-8. [PMID: 37059624 DOI: 10.1016/j.bja.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 04/16/2023] Open
Affiliation(s)
- Romain Bringier
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
| | - Alessandro Arrigoni
- Simbio Onlus, Sistemi Innovativi di Mantenimento della Biodiversità, Santa Maria Hoè, Italy; Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada
| | - Jane Muret
- Institut Curie PSL Research University, Paris, France
| | - Antoine Dro
- Department of Biomedical Engineering, Lariboisière, Saint Louis Hospitals, Paris, France
| | - Etienne Gayat
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France; Université Paris Cité, Inserm, U942 MASCOT, Paris, France
| | - Fabrice Vallée
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France; Université Paris Cité, Inserm, U942 MASCOT, Paris, France; Inria, Paris, France; LMS, École Polytechnique, CNRS, Paris, France
| | - Stefano Arrigoni Marocco
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
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4
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Ho E, Wagh A, Hogarth K, Murgu S. Single-Use and Reusable Flexible Bronchoscopes in Pulmonary and Critical Care Medicine. Diagnostics (Basel) 2022; 12:174. [PMID: 35054345 PMCID: PMC8775174 DOI: 10.3390/diagnostics12010174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions.
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Affiliation(s)
- Elliot Ho
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Ajay Wagh
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
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Harrison SL, Ahmad I, Elwen F, Curtis A, Dua G, Surda P, Johnstone C. Awake tracheal intubation with the ProVu™ video stylet: a case series. Anaesth Rep 2021; 9:e12102. [PMID: 33817645 DOI: 10.1002/anr3.12102] [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] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
Management of the difficult airway is integral to peri-operative practice. The development of devices to simplify airway handling are changing our approach to tracheal intubation. We report a case series of three patients who underwent awake tracheal intubation with the ProVu™ video stylet (Flexicare Medical Ltd, Mountain Ash, UK). All three patients had predicted difficult airways, including: limited mouth opening secondary to radiotherapy; previous exenteration, hemi-maxillectomy and scapular free flap formation; and cervical fixation. Awake tracheal intubation was performed successfully in all three cases, with no complications reported. This is the first reported case series of the ProVu™ video stylet as an awake tracheal intubation device. The benefits and limitations of this video stylet are discussed.
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Affiliation(s)
- S-L Harrison
- Department of Anaesthesia and Peri-operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
| | - I Ahmad
- Department of Anaesthesia and Peri-operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
| | - F Elwen
- Department of Anaesthesia King's College Hospital London UK
| | - A Curtis
- Department of Anaesthesia and Peri-operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
| | - G Dua
- Department of Anaesthesia and Peri-operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
| | - P Surda
- Department of Otolaryngology Guy's and St Thomas' NHS Foundation Trust London UK
| | - C Johnstone
- Department of Anaesthesia and Peri-operative Medicine Guy's and St Thomas' NHS Foundation Trust London UK
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6
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Matek J, Kolek F, Klementova O, Michalek P, Vymazal T. Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel) 2021; 11:diagnostics11030575. [PMID: 33810158 PMCID: PMC8004982 DOI: 10.3390/diagnostics11030575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12800 Prague, Czech Republic;
- Medical Faculty, Masaryk University, 62500 Brno, Czech Republic
| | - Frantisek Kolek
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
| | - Olga Klementova
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, I.P. Pavlova 185, Nová Ulice, 77900 Olomouc, Czech Republic;
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 499/2, 12808 Praha, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Tomas Vymazal
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
- Correspondence: ; Tel.: +420-606-413-489
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7
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Singleton BN, Morris FK, Yet B, Buggy DJ, Perkins ZB. Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis. Br J Anaesth 2021; 126:1055-1066. [PMID: 33610262 DOI: 10.1016/j.bja.2020.12.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. After critical appraisal, a random-effects network meta-analysis was used to pool and compare device performance. The primary outcome was the probability of first-attempt intubation success (first-pass success). For relative performance, the Macintosh direct laryngoscopy blade was chosen as the reference device. RESULTS We included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19-46.20), C-MAC D Blade™ (OR=7.44; 95% CrI, 1.06-52.50), Airtraq™ (OR=5.43; 95% CrI, 2.15-14.2), King Vision™ (OR=4.54; 95% CrI, 1.28-16.30), and C-MAC™ (OR=4.20; 95% CrI=1.28-15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR=3.54; 95% CrI, 1.05-12.50). Only the Airway Scope™ had a better probability of first-pass success compared with the Macintosh when manual-in-line stabilisation (MILS) was used as the immobilisation technique (OR=7.98; 95% CrI, 1.06-73.00). CONCLUSIONS For intubation performed with cervical immobilisation, seven devices had a better probability of first-pass success compared with the Macintosh. However, more studies using MILS (rather than a cervical collar or other alternative) are needed, which more accurately represent clinical practice. CLINICAL TRIAL REGISTRATION PROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067).
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Affiliation(s)
- Barry N Singleton
- Department of Anaesthesiology and Critical Care Medicine, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
| | - Fiachra K Morris
- Department of Anaesthesiology and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Barbaros Yet
- Graduate School of Informatics, Middle East Technical University, Ankara, Turkey
| | - Donal J Buggy
- Department of Anaesthesiology and Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland
| | - Zane B Perkins
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
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Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services. Respir Res 2020; 21:320. [PMID: 33267892 PMCID: PMC7709094 DOI: 10.1186/s12931-020-01576-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.
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Ahmad I, Jeyarajah J, Nair G, Ragbourne SC, Vowles B, Wong DJN, El-Boghdadly K. A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams. Can J Anaesth 2020; 68:196-203. [PMID: 32886298 PMCID: PMC7472940 DOI: 10.1007/s12630-020-01804-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose Because of the anticipated surge in cases requiring intensive care unit admission, the high aerosol-generating risk of tracheal intubation, and the specific requirements in coronavirus disease (COVID-19) patients, a dedicated Mobile Endotracheal Rapid Intubation Team (MERIT) was formed to ensure that a highly skilled team would be deployed to manage the airways of this cohort of patients. Here, we report our intubation team experience and activity as well as patient outcomes during the COVID-19 pandemic. Methods The MERIT members followed a protocolized early tracheal intubation model. Over a seven-week period during the peak of the pandemic, prospective data were collected on MERIT activity, COVID-19 symptoms or diagnosis in the team members, and demographic, procedural, and clinical outcomes of patients. Results We analyzed data from 150 primary tracheal intubation episodes, with 101 (67.3%) of those occurring in men, and with a mean (standard deviation) age of 55.7 (13.8) yr. Black, Asian, and minority ethnic groups accounted for 55.7% of patients. 91.3% of tracheal intubations were performed with videolaryngoscopy, and the first pass success rate was 88.0%. The 30-day survival was 69.2%, and the median [interquartile range] length of critical care stay was 11 [6–20] days and of hospital stay was 12 [7–22] days. Seven (11.1%) MERIT healthcare professionals self-isolated because of COVID-19 symptoms, with a total 41 days of clinical work lost. There was one reported incident of a breach of personal protective equipment and multiple anecdotal reports of doffing breaches. Conclusion We have shown that a highly skilled designated intubation team, following a protocolized, early tracheal intubation model may be beneficial in improving patient and staff safety, and could be considered by other institutions in future pandemic surges. Electronic supplementary material The online version of this article (10.1007/s12630-020-01804-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Imran Ahmad
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Jeyanjali Jeyarajah
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Ganeshkrishna Nair
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Sophie C Ragbourne
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Benjamin Vowles
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Danny J N Wong
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Kariem El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas', NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
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Kriege M, Dalberg J, McGrath BA, Shimabukuro-Vornhagen A, Billgren B, Lund TK, Thornberg K, Christophersen AV, Dunn MJ. Evaluation of intubation and intensive care use of the new Ambu® aScope™ 4 broncho and Ambu® aView™ compared to a customary flexible endoscope a multicentre prospective, non-interventional study. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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11
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Châteauvieux C, Farah L, Guérot E, Wermert D, Pineau J, Prognon P, Borget I, Martelli N. Single-use flexible bronchoscopes compared with reusable bronchoscopes: Positive organizational impact but a costly solution. J Eval Clin Pract 2018; 24:528-535. [PMID: 29573067 DOI: 10.1111/jep.12904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES There is at present no standard methodology to analyse the organizational impacts (OIs) of medical devices (MDs), and the field is still in its infancy. The aim of the present study was to assess, at a hospital level, the organizational and economic impacts of the introduction of a new MD, specifically the single-use flexible bronchoscope (FB). METHODS Both the organizational and economic impacts of the single-use FB were evaluated in comparison with the reusable FB currently used as standard practice in our institution. First, process maps were created for both devices (reusable and single use). Based on the 12 types of OI defined by Roussel et al, interviews were conducted with all stakeholders, and the positive and negative aspects of the reusable and single-use processes were analysed. In a second step, microcosting analysis was conducted to determine the most economical balance in use of the 2 technologies. RESULTS Process maps highlighted the complexity of the reusable device process when compared with the single-use device process. Among the 12 types of OI, the single-use FB process scored better than the reusable FB process in 75% of cases. With the "fleet" of 15 reusable FBs available in our institution, using single-use FBs would represent an extra cost of €154 per procedure. Single-use and reusable devices would have the same cost (€232 per procedure) with a theoretical annual activity of 328 bronchoscopies, which is much lower than our current activity (1644 procedures per year). CONCLUSIONS Organizational impact should be considered when assessing MDs. We show in this study that from an organizational viewpoint, there are many advantages to using single-use bronchoscopes. However, in economic impact, it is more cost-effective for our institution, with more than 1500 bronchoscopies performed annually, to use reusable devices.
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Affiliation(s)
| | - Line Farah
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Emmanuel Guérot
- Medical ICU, Georges Pompidou European Hospital, Paris, France
| | - Delphine Wermert
- Department of Pneumology Intensive Care, Georges Pompidou European Hospital, Paris, France
| | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Isabelle Borget
- GRADES, Univ. Paris-Sud, Université Paris Saclay, Châtenay-Malabry, France.,Department of Health Economics, Gustave Roussy Institute, Villejuif, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France.,GRADES, Univ. Paris-Sud, Université Paris Saclay, Châtenay-Malabry, France
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12
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Perbet S, Blanquet M, Mourgues C, Delmas J, Bertran S, Longère B, Boïko-Alaux V, Chennell P, Bazin JE, Constantin JM. Cost analysis of single-use (Ambu ® aScope™) and reusable bronchoscopes in the ICU. Ann Intensive Care 2017; 7:3. [PMID: 28050896 PMCID: PMC5209315 DOI: 10.1186/s13613-016-0228-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
Background Flexible optical bronchoscopes are essential for management of airways in ICU, but the conventional reusable flexible scopes have three major drawbacks: high cost of repairs, need for decontamination, and possible transmission of infectious agents. The main objective of this study was to measure the cost of bronchoalveolar lavage (BAL) and percutaneous tracheostomy (PT) using reusable bronchoscopes and single-use bronchoscopes in an ICU of an university hospital. The secondary objective was to compare the satisfaction of healthcare professionals with reusable and single-use bronchoscopes. Methods The study was performed between August 2009 and July 2014 in a 16-bed ICU. All BAL and PT procedures were performed by experienced healthcare professionals. Cost analysis was performed considering ICU and hospital organization. Healthcare professional satisfaction with single-use and reusable scopes was determined based on eight factors. Sensitivity analysis was performed by applying discount rates (0, 3, and 5%) and by simulation of six situations based on different assumptions. Results At a discount rate of 3%, the costs per BAL for the two reusable scopes were 188.86€ (scope 1) and 185.94€ (scope 2), and the costs per PT for the reusable scope 1 and scope 2 and single-use scopes were 1613.84€, 410.24€, and 204.49€, respectively. The cost per procedure for the reusable scopes depended on the number of procedures performed, maintenance costs, and decontamination costs. Healthcare professionals were more satisfied with the third-generation single-use Ambu® aScope™. Conclusions The cost per procedure for the single-use scope was not superior to that for reusable scopes. The choice of single-use or reusable bronchoscopes in an ICU should consider the frequency of procedures and the number of bronchoscopes needed. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Perbet
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France. .,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France. .,Réanimation Médico-Chirugicale, Pôle de Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand Cedex, France.
| | - M Blanquet
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C Mourgues
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - J Delmas
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - S Bertran
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Longère
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - V Boïko-Alaux
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Chennell
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-E Bazin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-M Constantin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
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13
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Reena. Use of Ambu® aScope™ 3 in difficult airway management in giant lipoma neck. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Reena
- Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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14
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Kleine-Brueggeney M, Greif R, Urwyler N, Wirthmüller B, Theiler L. The performance of rigid scopes for tracheal intubation: a randomised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2016; 71:1456-1463. [DOI: 10.1111/anae.13626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/26/2022]
Affiliation(s)
- M. Kleine-Brueggeney
- Department of Perioperative Medicine; Barts Heart Centre; Barts Health NHS Trust; London UK
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - R. Greif
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - N. Urwyler
- Department of Internal Medicine; Spitalzentrum Oberwallis; Brig Switzerland
| | - B. Wirthmüller
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Theiler
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
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15
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Artime CA, Altamirano A, Normand KC, Ferrario L, Aijazi H, Cattano D, Hagberg CA. Flexible optical intubation via the Ambu Aura-i vs blind intubation via the single-use LMA Fastrach: a prospective randomized clinical trial. J Clin Anesth 2016; 33:41-6. [DOI: 10.1016/j.jclinane.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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16
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Fukada T, Tsuchiya Y, Iwakiri H, Ozaki M. Is the Ambu aScope 3 Slim single-use fiberscope equally efficient compared with a conventional bronchoscope for management of the difficult airway? J Clin Anesth 2016; 30:68-73. [DOI: 10.1016/j.jclinane.2015.12.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 12/16/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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17
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Investigation of a cause–effect relationship between flexible bronchoscopy and pneumothorax in patients with severe acute respiratory distress syndrome. Eur J Anaesthesiol 2015; 32:896-8. [DOI: 10.1097/eja.0000000000000290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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18
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Khalifa OSM. Evaluation of Ambu® aScope™ 2 in awake nasotracheal intubation in anticipated difficult airway using conventional or facilitated technique: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2015. [DOI: 10.1016/j.egja.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Randomised Controlled trial Comparing the Ambu® aScope™2 with a Conventional Fibreoptic Bronchoscope in Orotracheal Intubation of Anaesthetised Adult Patients. Anaesth Intensive Care 2015; 43:479-84. [DOI: 10.1177/0310057x1504300410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fibreoptic intubation remains an essential skill for anaesthetists to master. In addition to the reusable fibrescope, an alternative disposable videoscope is available (aScope™2, Ambu®, Ballerup, Denmark). A total of 60 anaesthetised adult patients were randomised to either having orotracheal intubation using the aScope 2 or a Karl Storz fibrescope. Intubations were performed by experienced operators who were familiar with both devices. The primary outcome was the Global Rating Scale score. Secondary outcomes included intubation success, number of intubation attempts and intubation time. Other subjective outcomes including practicality, useability and image quality were also recorded. There was no significant difference in the Global Rating Scale score, intubation success or intubation time between the aScope 2 or Karl Storz fibrescope. Global Rating Scale scores were three and two in the aScope 2 and Karl Storz groups respectively ( P=0.14). All of the other subjective outcomes were similar between the two groups, except that operators found it easier to use the aScope 2 compared to the fibrescope. There was no significant difference in clinical performance between the aScope 2 and the Karl Storz fibreoptic bronchoscope. The aScope's practicality, disposability and recently improved version (aScope™3) potentially make it an acceptable alternative to the reusable fibrescope.
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20
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Tracheal Intubation with Aura-i and aScope-2: How to Minimize Apnea Time in an Unpredicted Difficult Airway. Case Rep Anesthesiol 2015; 2015:453547. [PMID: 25632355 PMCID: PMC4302980 DOI: 10.1155/2015/453547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/05/2014] [Accepted: 12/24/2014] [Indexed: 11/18/2022] Open
Abstract
The supraglottic airway's usefulness as a dedicated airway is the subject of continuing development. We report the case of an obese patient with unpredicted difficult airway management in which a new “continuous ventilation technique” was used with the Aura-i laryngeal mask and the aScope-2 devices. The aScope-2/Aura-i system implemented airway devices for the management of predictable/unpredictable difficult airway. The original technique required the disconnection of the mount catheter from Aura-i, the introduction of the aScope-2 into the laryngeal mask used as a conduit for video assisted intubation and then towards the trachea, followed by a railroading of the tracheal tube over the aScope-2. This variation in the technique guarantees mechanical ventilation during the entire procedure and could prevent the risk of hypoventilation and/or hypoxia.
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21
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22
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Mankikian J, Ehrmann S, Guilleminault L, Le Fol T, Barc C, Ferrandière M, Boulain T, Dequin PF, Guillon A. An evaluation of a new single-use flexible bronchoscope with a large suction channel: reliability of bronchoalveolar lavage in ventilated piglets and initial clinical experience. Anaesthesia 2014; 69:701-6. [PMID: 24773281 DOI: 10.1111/anae.12641] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 11/27/2022]
Abstract
A single-use flexible bronchoscope with a large suction channel has become available recently and we have evaluated this innovative device. Firstly, bronchoalveolar lavage was performed and quantified in ventilated piglets. Next, the bronchoscope was evaluated in three intensive care units and a satisfaction questionnaire was carried out. Sixteen bronchoalveolar lavages were performed in piglets with a recovery rate of 83 (79-86 [72-89])% of the instilled volume. Quality and performance of all devices tested was identical. The medical satisfaction questionnaire was as follows: 'acceptable' to 'very good' for quality of aspiration, manoeuvrability and quality of vision; 'very good' to 'perfect' for setting up and insertion. This encouraging preliminary evaluation demonstrates the effectiveness of this new single-use device, which may obviate the need for disinfection procedures and, thereby, eradicate a potential vector of patient cross-contamination.
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Affiliation(s)
- J Mankikian
- CHRU de Tours, Service de Réanimation Polyvalente, Tours, France
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23
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Utilisation d’un fibroscope à usage unique pour la formation sur labyrinthe à l’intubation sous fibroscope. ACTA ACUST UNITED AC 2014; 33:12-5. [DOI: 10.1016/j.annfar.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/05/2013] [Indexed: 11/22/2022]
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24
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