Airway devices for awake tracheal intubation in adults: a systematic review and network meta-analysis

Desai, Neel; Ratnayake, Gamunu; Onwochei, Desire N.; El‐Boghdadly, Kariem; Ahmad, Imtiaz

doi:10.1016/j.bja.2021.05.025

Cited by 17 publications

(9 citation statements)

References 49 publications

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“…supported awake intubation with devices such as video laryngoscopes and fiberoptic stylets and concluded them to be clinically comparable to awake fibreoptic intubation. 17 The individual doctor rarely encounters situations where the procedure fails. It is therefore important for clinicians to learn the pitfalls of fiberoptic intubation from the studies performed.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review and meta-analysis, including 12 randomized trials of airway devices during awake intubation, found awake fibreoptic intubation, video laryngoscopy, and optical stylets to have comparable results with respect to both success rate and procedural complications. 17 There are several studies that have investigated the incidence of failed awake intubation. Less is known from larger study populations about the clinical context in which the failure occurs, and how the airway is secured when fiberoptic awake intubation fails.…”

Section: Introductionmentioning

confidence: 99%

“…3,17 A recent meta-analysis T A B L E 2 An overview of clinical problems causing failure of awake fiberoptic intubation, and airway procedures applied to secure the airway.…”

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confidence: 99%

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Incidence, causes, and management of failed awake fibreoptic intubation—A retrospective study of 833 procedures

Karlsen,

Gisvold,

Nordseth

et al. 2023

Acta Anaesthesiol Scand

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Awake fibreoptic intubation has been considered a gold standard in the management of the difficult airway. However, failure may cause critical situations. The aim of this study was to investigate the incidence and causes of failed awake fibreoptic intubation at a tertiary care hospital. The study was conducted at St. Olav University Hospital in Trondheim, Norway. Problems occurring during anaesthesia are routinely recorded in the electronic anaesthesia information system (Picis Clinical Solutions Inc.), including difficult intubations. We applied text search on all anaesthesia records between 2011 and 2021 and identified 833 awake fibreoptic intubations. The anaesthesia records were examined to identify failed awake fibreoptic intubations, the cause of failure and how the airway ultimately was secured. Among 233,938 patients who received anaesthesia, 90,397 received tracheal intubation and 833 received awake fibreoptic intubation. Twenty‐nine of the procedures failed. In nine patients the failure caused loss of airway control with desaturation and hypoventilation. The major causes of failure were dislodged tube after induction of general anaesthesia (n = 8), patient distress (n = 5), tube not able to pass (n = 5), and airway bleeding (n = 3). The situations were primarily solved using direct laryngoscopy, with or without bougie, or with video laryngoscopy. Tracheostomy was performed in four patients. Awake fibreoptic intubation failed in 3.5% of patients, most often due to dislocation, problems passing the tracheal tube, or patient discomfort. The failure rate was higher than in previous studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence, causes, and management of failed awake fibreoptic intubation—A retrospective study of 833 procedures

Karlsen,

Gisvold,

Nordseth

et al. 2023

Acta Anaesthesiol Scand

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“…Cabe destacar que, en sujetos con tumores de cabeza y cuello de forma anticipada, con una reserva fisiológica adecuada, se podría utilizar la intubación vigil o disociación del sujeto permitiendo una ventilación espontánea para prevenir y/o evitar la pérdida de tono muscular de la zona, asociado a los fármacos inductores y paralizantes, que podrían contribuir al cierre irreversible de la VA, sobre todo en tumores infraglóticos o con ocupamiento mediastínico. Para ello sería recomendado el uso de fibrobroncoscopio para la visualización de la VA, el cual no está disponible habitualmente en las unidades de urgencias (Ahmad et al, 2020;Desai et al, 2021).…”

Section: Discussionunclassified

Intubación endotraqueal de emergencia en paciente con estridor inspiratorio y hallazgo de tumor en cuerdas vocales: reporte de un caso

Vidal¹,

Aravena²

2022

ARS med

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El manejo especializado de la vía aérea (VA) es fundamental en las unidades de urgencia donde la intubación orotraqueal ha sido la técnica de elección para lograrlo. Una VA difícil se define como una situación clínica en la cual un equipo médico entrenado experimenta dificultades en la ventilación y/o en intubación. La obstrucción aguda de la VA constituye una de las emergencias médicas más extremas, requiriendo intervención inmediata. Se presenta el caso de un paciente con estridor inspiratorio con criterios inmediatos de intubación donde se evidencia un tumor en cuerdas vocales con obstrucción de la vía aérea.

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“…Some relevant studies have shown that the success rate of awake fiberoptic bronchoscope intubation was 78-100% (19)(20)(21)(22). Although fiberoptic bronchoscopy is advised for difficult airways, it takes considerable training to obtain the skill, particularly for novice residents (23,24). In addition, fiberoptic bronchoscope is easily affected by sputum and secretions from the oropharynx or nasopharynx, making the glottis difficult to identify.…”

Section: Discussionmentioning

confidence: 99%

A learning curve of a novel multimodal endotracheal intubation assistant device for novices in a simulated airway: a prospective manikin trial with cumulative sum method

Xia¹,

Xu²,

Cao³

et al. 2022

Transl Pediatr

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Background Awake fiberoptic intubation is conventionally performed in anticipated difficult airways. However, obstruction by secretions and sputum makes it challenging for novices. A prototype of a novel multimodal endotracheal intubation assistant device (MEIAD) was developed for an indication of airway according to end-tidal carbon dioxide (ETCO 2 ) and image. At the tip, 4 sampling tubes collected ETCO 2 concentration. The airway direction is located according to an advanced algorithm based on 4 directions’ concentrations. It assists awake intubation, especially with unclear view field. The objective was to analyze the learning curve of MEIAD for novices on a manikin by cumulative sum method (CUSUM) and evaluate the utility. Methods A total of 16 novice residents with less than 2-year clinical experience were enrolled. After instruction, each individual exercised 40 insertions with MEIAD on a difficult airway simulation. Insertion success (defined as a visualization of the carina within 120 seconds), insertion time (the time from when the guiding scope entered the nasal cavity to the carina was visible), and self-confidence score (subjective score with a numerical rating scale from 0 to 10) were recorded. The acceptable and unacceptable failure rates of CUSUM were set as 15% and 30%, respectively. The exercises were divided into 2 phases (phase 1: 1–20, phase 2: 21–40) for further evaluation. All continuous data were expressed by median (IQR, interquartile ranges) and analyzed using Mann-Whitney test. All categorical variables were expressed as percentages and compared by the χ 2 test. Results Among the 16 residents, 15 were able to cross the lower decision boundary in an average of 21.27±9.51 attempts using the novel device. The insertion time [24.0 (17.0–42.0) vs. 17.5 (14.0–28.0) seconds, P<0.001] and success rate (88.4% vs. 97.5%, P<0.001) were improved with increased experience. The confidence score was significantly improved from 2.5 (1.3–4.0) to 7.0 (7.0–8.0). Conclusions MEIAD showed a satisfactory learning curve and efficacy on the manikin for novices. However, as a small exploratory manikin trial, the results cannot be replicated in clinical practice. MEIAD is expected to be further improved and potential to be an alternative device for difficult airways.

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Airway devices for awake tracheal intubation in adults: a systematic review and network meta-analysis

Cited by 17 publications

References 49 publications

Incidence, causes, and management of failed awake fibreoptic intubation—A retrospective study of 833 procedures

Incidence, causes, and management of failed awake fibreoptic intubation—A retrospective study of 833 procedures

Intubación endotraqueal de emergencia en paciente con estridor inspiratorio y hallazgo de tumor en cuerdas vocales: reporte de un caso

A learning curve of a novel multimodal endotracheal intubation assistant device for novices in a simulated airway: a prospective manikin trial with cumulative sum method

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