Prospective validation of a new airway management algorithm and predictive features of intubation difficulty
| Autor: | N. Daami, C. Cherait, David Lobo, K. Abbay, Roman Mounier, Bouziane Aït-Mamar, Hakim Haouache, Gilles Dhonneur, Mathieu Martin, V. Slavov, Fabrice Cook, N.-E. Saïdi, K. Younsi, S. Bloc, N. Imbert, S. Bensaid, P. Goater, J. Jaubert, H. Grati, J. Catineau, K. Abdelhafidh |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_treatment Laryngoscopy Anesthesia General Logistic regression 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests 030202 anesthesiology Intubation Intratracheal Humans Medicine Intubation Prospective Studies Airway Management Aged Mouth medicine.diagnostic_test business.industry Decision Trees Tracheal intubation Middle Aged Stylet Management algorithm Treatment Outcome Anesthesiology and Pain Medicine Feature (computer vision) Anesthesia Cervical Vertebrae Female Airway management business Algorithms |
| Zdroj: | British Journal of Anaesthesia. 122:245-254 |
| ISSN: | 0007-0912 |
| DOI: | 10.1016/j.bja.2018.09.021 |
| Popis: | Background Some patients have features that indicate possible difficulty with direct laryngoscopy for tracheal intubation. Prediction of the likely outcome and selection of patients for an enhanced management algorithm would reduce the possible harm from failed intubation attempts. Methods Adult elective patients were assessed for seven features associated with difficult direct laryngoscopy, ranked in difficulty from 0 to 3. For a patient with at least one Class 3 feature, or two or more features of class 1 or higher, the enhanced management used a channelled videolaryngoscope Airtraq™ instead of a Macintosh laryngoscope. A long flexible angulated stylet and a flexible fibrescope would be used as the second and third steps. For patients with lesser difficulty scores, a Macintosh laryngoscope was used. Outcomes of enhanced management were analysed. Logistic regression and Random Forest algorithm, using the ranks of the predictive features, were used to predict difficulty during enhanced management. Results We prospectively studied 16 695 patients. We selected 1501 (9%) for enhanced management, and tracheal intubation was successful in all of them. Of these, 73% were intubated in less than 30 s, and only 4.5% required more than 4 min for intubation. Progression to the second and third steps of enhanced management was predicted by restriction of mouth opening and reduced cervical spine mobility. Conclusions An enhanced management algorithm allowed successful tracheal intubation of all patients with anticipated difficult laryngoscopy. The need to combine the use of a stylet and a fibrescope with the Airtraq™ could be predicted with a high degree of certainty. |
| Databáze: | OpenAIRE |
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