Ellenőrző lista hatása a légútbiztosítás korai szövődményeire felnőttekben

Abstract

Introduction: Airway management is an integral part of general anaesthesia, which may lead to severe short- and long-term complications. Aim: We assessed whether the application of a checklist for the steps of airway management reduces the number of complications in our institute. Method: In our observational, prospective, controlled study we made a checklist and a data collection sheet. Each airway management was performed for one month without the checklist and then for one month in the possession of the checklist. We evaluated the outcome of airway maneuvers and the occurrence of related early complications before and after the introduction of the checklist. The primary endpoint was the incidence of unexpected difficult airway. The secondary endpoints were difficult intubation, successful first intubation, aspiration, cardiac arrest, post-induction hypotension and desaturation, soft tissues/teeth injuries. Our results were also corrected for factors that affect the risk of complications (urgency of interventions, medical experience). Results: We did not find any difference in the frequency of acute complications before the introduction of the checklist (n = 439) and during the subsequent period (n = 423). At the primary endpoint (7.29% and 6.14%), there was no substantive difference (1.15%, 95% CI: –2.26%–4.56%, p = 0.5). No differences were found regarding the secondary and other endpoints. Following the correction of risk factors, there was no impact of the checklist on the incidence of complications. Conclusion: The introduction of the checklist in itself did not result in a significant change in the risk of short-term complications of airway management in our institution. Orv Hetil. 2019; 160(26): 1025–1035.

Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes

“…After screening of titles and abstracts, 1607 citations were excluded, and 42 articles JAMA Network Open | Anesthesiology underwent full-text review, with 11 meeting inclusion criteria. 1,[24][25][26][27][28][29][30][31][32][33] Reasons for exclusion are listed in Figure 1. We requested clarification about inclusion criteria from the authors of 2 studies.…”

“…Across the 11 included studies, 1,[24][25][26][27][28][29][30][31][32][33] there were a total of 3261 ETIs performed in 13 institutions in 6 countries. Table 1 gives the characteristics of the individual studies.…”

“…Only 1 (ICU-based) study 28 was a randomized clinical trial. Eight studies [24][25][26][27]29,30,32,33 used a beforeand-after observational design, with 6 studies 25,26,29,30,32,33 being prospective and 2 studies 24,27 being retrospective. The remaining 2 studies 1,31 were prospective case series.…”

“…Five studies [25][26][27]29,30 included significant cointerventions (such as health care professional education, equipment changes, health care professional team modeling, and medication changes) in addition to a checklist. Preintubation checklist details were reported in 8 studies [24][25][26][27][28][29]32,33 and were heterogeneous. Most checklists included assessment of preoxygenation and medication, but other checklist components were inconsistent (eTable in the Supplement).…”

“…Two studies 26,27 defined hypotension as a decrease in blood pressure that required intervention with fluid bolus or vasopressor. Other studies 25,28,30,32,33 used definitions that included a systolic blood pressure from 70 to 90 mm Hg.…”