Extubation over a bougie in difficult airways: are we missing a trick?

Smith, T.G.C.; Vaughan, David J.

doi:10.1111/anae.12400

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…Furthermore, the chance of an esophageal dislocation should be a strong argument against the application of oxygen via the AEC, as has been pointed out by others [6][7][8]. Our dislocation rate of 4.4% was even smaller than reported before: A small audit in 18 patients revealed a dislocation rate of 11%, a further 11% did not tolerate the AEC [9].…”

Section: Discussionsupporting

confidence: 50%

Dislocation rates of postoperative airway exchange catheters. A prospective case series of 200 patients.

Roten

Steffen

Kleine‐Brueggeney

et al. 2019

Preprint

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BACKGROUND: The dislocation rate of oral versus nasal airway exchange catheters (AEC) in the postoperative care unit (PACU) are unknown. Our aim was to establish dislocation rates and to assess the usefulness of waveform capnography to detect dislocation. METHODS: In this non-randomized, prospective observational trial at the University Hospital Bern, Switzerland, we included 200 patients admitted to PACU after extubation via AEC, having provided written informed consent. The study was approved by the local ethical committee. AEC position was assessed by nasal fiberoptic endoscopy at beginning of PACU stay and before removal of the AEC. Capnography was continuously recorded via the AEC. Additional measurements included retching and coughing of the patient, and re-intubation, if necessary. RESULTS: Data from 182 patients could be evaluated regarding dislocation. Overall dislocation rate was not different between oral and nasal catheters (7.2% vs. 2.7%, p=0.16). Retching was more often noted in oral catheters (26% vs. 8%, p<0.01). Waveform capnography was unreliable in predicting dislocation (negative predictive value 17%). Re-intubation was successful in all five of the nine re-intubations where an AEC was still in situ. In four patients, the AEC was already removed when re-intubation became necessary, and re-intubation failed once, with a front of neck access as a rescue maneuver. CONCLUSIONS: We found no difference in dislocation rate between nasal and oral position of an airway exchange catheter. However, nasal catheters seemed to be tolerated better. In the future, catheters like the staged extubation catheter may further increase tolerance. TRIAL REGISTRATION: The study was registered in a clinical study registry (ISRCTN 96726807) on 10/06/2010.

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Section: Discussionsupporting

confidence: 50%

Dislocation rates of postoperative airway exchange catheters. A prospective case series of 200 patients.

Roten

Steffen

Kleine‐Brueggeney

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…The use of the bougie has expanded over the years, and studies and case reports have described its use to aid difficult extubation , accurate placement of a second‐generation laryngeal mask airways such as the Proseal LMA and more recently, cricothyrotomy . There is evidence to suggest that use of the bougie in conjunction with a laryngoscope improves success rates and may be safer when performing intubation in patients with cervical spine injuries, as it reduces the forces exerted on the cervical spine .…”

mentioning

confidence: 99%

The humble bougie…forty years and still counting?

Rai

2014

Anaesthesia

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“…Furthermore, the chance of an esophageal dislocation should be a strong argument against the application of oxygen via the AEC, as has been pointed out by others [6–8]. Our dislocation rate of 4.4% was even smaller than reported before: A small audit in 18 patients revealed a dislocation rate of 11%, a further 11% did not tolerate the AEC [9].…”

Section: Discussionmentioning

confidence: 48%

Dislocation rates of postoperative airway exchange catheters - a prospective case series of 200 patients

et al. 2019

View full text Add to dashboard Cite

Background The dislocation rate of oral versus nasal airway exchange catheters (AEC) in the postoperative care unit (PACU) are unknown. Our aim was to establish dislocation rates and to assess the usefulness of waveform capnography to detect dislocation. Methods In this non-randomized, prospective observational trial at the University Hospital Bern, Switzerland, we included 200 patients admitted to PACU after extubation via AEC, having provided written informed consent. The study was approved by the local ethical committee. AEC position was assessed by nasal fiberoptic endoscopy at beginning of PACU stay and before removal of the AEC. Capnography was continuously recorded via the AEC. Additional measurements included retching and coughing of the patient, and re-intubation, if necessary. Results Data from 182 patients could be evaluated regarding dislocation. Overall dislocation rate was not different between oral and nasal catheters (7.2% vs. 2.7%, p = 0.16). Retching was more often noted in oral catheters (26% vs. 8%, p < 0.01). Waveform capnography was unreliable in predicting dislocation (negative predictive value 17%). Re-intubation was successful in all five of the nine re-intubations where an AEC was still in situ. In four patients, the AEC was already removed when re-intubation became necessary, and re-intubation failed once, with a front of neck access as a rescue maneuver. Conclusions We found no difference in dislocation rate between nasal and oral position of an airway exchange catheter. However, nasal catheters seemed to be tolerated better. In the future, catheters like the staged extubation catheter may further increase tolerance. Trial registration The study was registered in a clinical study registry ( ISRCTN 96726807 ) on 10/06/2010.

show abstract

Extubation over a bougie in difficult airways: are we missing a trick?

Cited by 6 publications

References 7 publications

Dislocation rates of postoperative airway exchange catheters. A prospective case series of 200 patients.

Dislocation rates of postoperative airway exchange catheters. A prospective case series of 200 patients.

The humble bougie…forty years and still counting?

Dislocation rates of postoperative airway exchange catheters - a prospective case series of 200 patients

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