Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study
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...
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Veröffentlicht in: | Turkish journal of anaesthesiology and reanimation 2019-12, Vol.47 (6), p.464-470 |
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creator | Sanfilippo, Filippo Sgalambro, Francesco Chiaramonte, Giuseppe Santonocito, Cristina Burgio, Gaetano Arcadipane, Antonio |
description | 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.
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 naïve 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.
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 |
doi_str_mv | 10.5152/TJAR.2019.99234 |
format | Article |
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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 naïve 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.
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).
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.</description><identifier>ISSN: 2667-677X</identifier><identifier>EISSN: 2667-6370</identifier><identifier>DOI: 10.5152/TJAR.2019.99234</identifier><identifier>PMID: 31828243</identifier><language>eng</language><publisher>Turkey: Aves Yayincilik Ltd. STI</publisher><subject>Edema ; Intubation ; Laryngoscopy ; Original ; Success</subject><ispartof>Turkish journal of anaesthesiology and reanimation, 2019-12, Vol.47 (6), p.464-470</ispartof><rights>Copyright 2019 by Turkish Anaesthesiology and Intensive Care Society.</rights><rights>2019. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the associated terms available at https://turkjanaesthesiolreanim.org/en/aims-and-scope-1027</rights><rights>Copyright 2019 by Turkish Anaesthesiology and Intensive Care Society 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c421t-373b854b1058205069c0ee094293a0bae3d7d535b93bd845581c8b0069bc6e483</citedby><orcidid>0000-0001-8823-7253 ; 0000-0001-6876-6561 ; 0000-0001-6521-3806 ; 0000-0001-7294-7613 ; 0000-0001-5144-0776 ; 0000-0002-4213-9153</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886816/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886816/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31828243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanfilippo, Filippo</creatorcontrib><creatorcontrib>Sgalambro, Francesco</creatorcontrib><creatorcontrib>Chiaramonte, Giuseppe</creatorcontrib><creatorcontrib>Santonocito, Cristina</creatorcontrib><creatorcontrib>Burgio, Gaetano</creatorcontrib><creatorcontrib>Arcadipane, Antonio</creatorcontrib><creatorcontrib>“renato Fiandaca” Simulation Center, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy</creatorcontrib><creatorcontrib>Department of Anaesthesia and Intensive Care, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy</creatorcontrib><creatorcontrib>Department of Anaesthesia and Intensive Care, Istituto Oncologico Del Mediterraneo (iom), Viagrande, Italy</creatorcontrib><title>Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study</title><title>Turkish journal of anaesthesiology and reanimation</title><addtitle>Turk J Anaesthesiol Reanim</addtitle><description>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.
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 naïve 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.
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).
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.</description><subject>Edema</subject><subject>Intubation</subject><subject>Laryngoscopy</subject><subject>Original</subject><subject>Success</subject><issn>2667-677X</issn><issn>2667-6370</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpVkVtL5DAYhoO4qKjXeycBrzuTY5t6IdTRPciIy6rgXUjSdCbSJjVpd5l_v531gF7lgzx5vzc8AHzFaMYxJ_P76-r3jCBczsqSULYDDkieF1lOC7T7NhfF4z44TslpxBkjE033wD7FggjC6AFwD8nC0EAFF6HTztsaLlXc-FXILmLwZh2SCf0GVn0fgzJr6Dy8dE3jzNgOsHLxr9okeKO8WtnO-uEMVvCXa8MA71w3tmpwwcO7Yaw3R-BLo9pkj1_PQ_Dw7ep-8SNb3n7_uaiWmWEEDxktqBacaYy4IIijvDTIWlQyUlKFtLK0LmpOuS6prgXjXGAjNJo4bXLLBD0E5y-5_ag7W5upVFSt7KPrpo_JoJz8fOPdWq7CH5kLkQucTwGnrwExPI82DfIpjNFPnSXhTAgsMMUTNX-hTAwpRdu8b8BIbvXIrR651SP_65lenHws9s6_yaD_AM5pi3A</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Sanfilippo, Filippo</creator><creator>Sgalambro, Francesco</creator><creator>Chiaramonte, Giuseppe</creator><creator>Santonocito, Cristina</creator><creator>Burgio, Gaetano</creator><creator>Arcadipane, Antonio</creator><general>Aves Yayincilik Ltd. STI</general><general>Turkish Anaesthesiology and Intensive Care Society</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8823-7253</orcidid><orcidid>https://orcid.org/0000-0001-6876-6561</orcidid><orcidid>https://orcid.org/0000-0001-6521-3806</orcidid><orcidid>https://orcid.org/0000-0001-7294-7613</orcidid><orcidid>https://orcid.org/0000-0001-5144-0776</orcidid><orcidid>https://orcid.org/0000-0002-4213-9153</orcidid></search><sort><creationdate>20191201</creationdate><title>Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study</title><author>Sanfilippo, Filippo ; Sgalambro, Francesco ; Chiaramonte, Giuseppe ; Santonocito, Cristina ; Burgio, Gaetano ; Arcadipane, Antonio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c421t-373b854b1058205069c0ee094293a0bae3d7d535b93bd845581c8b0069bc6e483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Edema</topic><topic>Intubation</topic><topic>Laryngoscopy</topic><topic>Original</topic><topic>Success</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sanfilippo, Filippo</creatorcontrib><creatorcontrib>Sgalambro, Francesco</creatorcontrib><creatorcontrib>Chiaramonte, Giuseppe</creatorcontrib><creatorcontrib>Santonocito, Cristina</creatorcontrib><creatorcontrib>Burgio, Gaetano</creatorcontrib><creatorcontrib>Arcadipane, Antonio</creatorcontrib><creatorcontrib>“renato Fiandaca” Simulation Center, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy</creatorcontrib><creatorcontrib>Department of Anaesthesia and Intensive Care, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy</creatorcontrib><creatorcontrib>Department of Anaesthesia and Intensive Care, Istituto Oncologico Del Mediterraneo (iom), Viagrande, Italy</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Turkish journal of anaesthesiology and reanimation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanfilippo, Filippo</au><au>Sgalambro, Francesco</au><au>Chiaramonte, Giuseppe</au><au>Santonocito, Cristina</au><au>Burgio, Gaetano</au><au>Arcadipane, Antonio</au><aucorp>“renato Fiandaca” Simulation Center, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy</aucorp><aucorp>Department of Anaesthesia and Intensive Care, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy</aucorp><aucorp>Department of Anaesthesia and Intensive Care, Istituto Oncologico Del Mediterraneo (iom), Viagrande, Italy</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study</atitle><jtitle>Turkish journal of anaesthesiology and reanimation</jtitle><addtitle>Turk J Anaesthesiol Reanim</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>47</volume><issue>6</issue><spage>464</spage><epage>470</epage><pages>464-470</pages><issn>2667-677X</issn><eissn>2667-6370</eissn><abstract>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.
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 naïve 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.
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).
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.</abstract><cop>Turkey</cop><pub>Aves Yayincilik Ltd. STI</pub><pmid>31828243</pmid><doi>10.5152/TJAR.2019.99234</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8823-7253</orcidid><orcidid>https://orcid.org/0000-0001-6876-6561</orcidid><orcidid>https://orcid.org/0000-0001-6521-3806</orcidid><orcidid>https://orcid.org/0000-0001-7294-7613</orcidid><orcidid>https://orcid.org/0000-0001-5144-0776</orcidid><orcidid>https://orcid.org/0000-0002-4213-9153</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Edema Intubation Laryngoscopy Original Success |
title | Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study |
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