Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study
- 11 December 2019
- journal article
- research article
- Published by Galenos Yayinevi in Turkish Journal of Anaesthesiology and Reanimation
- Vol. 47 (6), 464-470
- https://doi.org/10.5152/tjar.2019.99234
Abstract
Objective: There are several airway devices available for difficult tracheal intubation (DTI) management, but the failure rate remains high. The use of laryngoscopy to facilitate the fibreoptic-bronchoscope intubation (CLBI) has been increasingly reported in DTI situations, but it has not been formally studied yet. Methods: We designed a single-centre simulation study on DTI (neck rigidity and tongue oedema) comparing three techniques: direct laryngoscopy (DL), video-laryngoscopy (VLS) and CLBI. Eighteen anaesthesiologists naive to VLS/CLBI approaches, participated in the study. The primary outcome was the intubation rate at the first attempt. Secondary outcomes were an overall time-to-intubate (TTI) and time-to-ventilate (TTV), success at the second and third attempt and ease of intubation as evaluated by a subjective 5-point Likert scale. Results: The CLBI technique had a higher success rate at the first attempt than DL (66% vs 22%, p=0.007), while VLS did not (44%, p=0.16). A trend towards higher success at the third attempt was found for both VLS and CLBI vs DL (p=0.07 and p=0.06, respectively). The VLS had a shorter overall TTV than DL (88 +/- 60 vs 121 +/- 59 sec, respectively, p=0.04) and a trend towards a shorter TTI (81 +/- 61 vs 116 +/- 64 sec, respectively, p=0.06). The CLBI approach showed a non-significantly lower TTI/TTV as compared to DL (p=0.10 and p=0.16, respectively). Anaesthesiologists judged that the intubation with VLS (3.7 +/- 1.0) and CLBI (3.8 +/- 1.0) was easier than with DL (1.7 +/- 0.8, both p<0.001). Conclusion: In a simulated DTI scenario, CLBI had a higher success rate at the first attempt than DL, while VLS did not. By the third attempt, both rescue techniques had a trend towards a higher success rate than DL. The CLBI technique seems a promising alternative for the management of DTI.This publication has 29 references indexed in Scilit:
- Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adultsBritish Journal of Anaesthesia, 2015
- Comparison between bougies and stylets for simulated tracheal intubation with the C-MAC D-blade videolaryngoscopeEuropean Journal of Anaesthesiology, 2015
- Bougie‐related airway trauma: dangers of the hold‐up signAnaesthesia, 2014
- First experience of the use of the C-MAC PM videolaryngoscope in a clinical setting by anesthetic nurses: a comparison with anesthetists.2013
- Learning Endotracheal Intubation Using a Novel Videolaryngoscope Improves Intubation Skills of Medical StudentsAnesthesia & Analgesia, 2011
- Combined use of an Airtraq® optical laryngoscope, Airtraq video camera, Airtraq wireless monitor, and a fibreoptic bronchoscope after failed tracheal intubationCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 2011
- Complications of awake fibreoptic intubation without sedation in 200 healthy anaesthetists attending a training courseBritish Journal of Anaesthesia, 2008
- A combined rigid videolaryngoscopy-flexible fibres copy intubation technique undergener al anesthesiaCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 2007
- Management of the Difficult AirwayAnesthesiology, 2005
- Complaints related to respiratory events in anaesthesia and intensive care medicine from 1994 to 1998 in DenmarkActa Anaesthesiologica Scandinavica, 2001