scholarly journals Pecha Kucha with Part-Task Training Improves Airway Management in Fresh Frozen Cadavers: A Case-Control Observational Study

2020 ◽  
Vol 29 (6) ◽  
pp. 532-537
Author(s):  
Kemal Tolga Saracoglu ◽  
Mehmet Yilmaz ◽  
Ayse Zeynep Turan ◽  
Alparslan Kus ◽  
Tuncay Colak ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Tracheal Tube ◽  
Complication Rate ◽  
Task Group ◽  
Tube Placement ◽  
Fiberoptic Intubation ◽  
Fresh Frozen ◽  
Task Training

<b><i>Objective:</i></b> The objective of this study was to ascertain whether the addition of part-task training as a step in Pecha Kucha for fiberoptic tracheal intubation increases the success rate and reduces the complication rate. <b><i>Subjects and Methods:</i></b> The residents of the Department of Anesthesiology were initially included in an orientation program. We used the Pecha Kucha method for the presentation of teaching fiberoptic intubation skills. Afterwards the participants were trained in Laerdal® airway management and each participant performed tracheal intubation using the Aintree catheter. The participants were divided into two groups. Group 1 (<i>n</i> = 9) received part-task training and group 2 (<i>n</i> = 9) received whole-task training. The tracheal intubation performances of participants were evaluated on fresh frozen cadavers. The number of interventions, incidence of complications, success rate, and optimization maneuver requirements were recorded. <b><i>Results:</i></b> Eighteen residents aged between 27 and 33 years were included. All were junior residents with less than 2 years of experience. There was no significant difference in terms of duration of tracheal intubation, complication rates, and optimization maneuvers between the study groups. Six participants could not place the tracheal tube in the last section. The success rates for the part-task group during Aintree and tracheal tube placement were 100 and 66.7%, respectively, whereas the rates were 55.6 and 44.4%, respectively, in whole-task group (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> In addition to the Pecha Kucha method in fiberoptic intubation training, simulation-based part-task training appears to increase the success rate and to reduce the complication rate on fresh frozen cadavers.

scholarly journals Optical Devices in Tracheal Intubation—State of the Art in 2020

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 575
Author(s):  
Jan Matek ◽  
Frantisek Kolek ◽  
Olga Klementova ◽  
Pavel Michalek ◽  
Tomas Vymazal
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Mouth Opening ◽  
Optical Devices ◽  
Tube Placement ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Endotracheal Tube Placement ◽  
Supraglottic Airway Devices ◽  
Thoracic Anesthesia

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

scholarly journals Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Comparison of Airtraq® Laryngoscope, Bonfils Endoscope and Fiberoptic Bronchoscope for Awake Tracheal Intubation: A Randomized, Controlled Trial

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Köhne W ◽  
◽  
Elfers-Wassenhofen A ◽  
Nosch M ◽  
Groeben H ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Local Anesthesia ◽  
Difficult Intubation ◽  
Spontaneous Breathing ◽  
Case Reports ◽  
Controlled Trial ◽  
Fiberoptic Intubation ◽  
Randomized Controlled ◽  
Glottic View

Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.

scholarly journals Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Linh T. Nguyen ◽  
Sudip D. Thakar ◽  
Angela T. Truong ◽  
Dam-Thuy Truong
Keyword(s):  
Tracheal Intubation ◽  
Adverse Events ◽  
Airway Management ◽  
Reliable Method ◽  
Orotracheal Intubation ◽  
Tube Placement ◽  
Dental Injury ◽  
Malpractice Litigation ◽  
Novel Approach ◽  
Anesthesia Providers

Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient.

scholarly journals Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Nobuyasu Komasawa ◽  
Akira Hyoda ◽  
Sayuri Matsunami ◽  
Nozomi Majima ◽  
Toshiaki Minami
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Difficult Airway Management ◽  
Intubation Time ◽  
Simulation Based ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Crossover Analysis ◽  
Airway Model

Background.Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Methods.Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time.Results.In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P=0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB.Conclusion.GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.

scholarly journals Analysis of Tracheal Intubation in Out-of-Hospital Helicopter Emergency Medicine Recorded by Video Laryngoscopy.

2020 ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Objective. Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success and especially first-pass intubation success (FPS) in these situations is imperative.Methods. We conducted a prospective observational study on all twelve helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, as well as circumstances and environmental factors, and the level of experience in airway management of the provider had to be filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy.Results. FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p<0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified.Conclusion. Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Efficacy of Stylet Angulation at the Holding Position During Tracheal Intubation with a Videolaryngoscope: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Ryo Wakabayashi ◽  
Yuki Shiko ◽  
Tomofumi Kodaira ◽  
Yuko Shiroshita ◽  
Hitomi Otsuka ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Tracheal Intubation ◽  
Tracheal Tube ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Tube Placement ◽  
Upper Arm ◽  
Randomized Controlled ◽  
The Mean ◽  
The Right

Abstract The aim of this randomized controlled trial was to determine the efficacy of stylet angulation at the holding position during tracheal intubation with a McGRATH™ MAC videolaryngoscope. Patients were randomized to a group for intubation without stylet angulation at the holding position (non-angulation group) and to a group for intubation with stylet angulation at the holding position (angulation group). The primary outcome was the time for placement of the tracheal tube. Sixty patients were analyzed. The mean (standard deviation) times for tube placement were 21.3 (5.6) s in the non-angulation group and 16.9 (3.8) s in the angulation group (P < 0.001). The scores of operator's perception of difficulty in tube delivery, number of attempts for tube delivery, and degrees of extension, abduction, internal rotation of the right upper arm and extension of the right wrist during tube placement in the angulation group were significantly smaller than those in the non-angulation group (P < 0.001, P = 0.002, P < 0.001, P < 0.001, P < 0.001, P < 0.001, respectively). Our results suggest that stylet angulation at the holding position improves maneuverability of the tracheal tube and enables easy tube placement during tracheal intubation with a McGRATH™ MAC videolaryngoscope.

scholarly journals The Most Accurate and Fastest Method for Confirmation of Endotracheal Intubation

2017 ◽  
Vol 5 (4) ◽  
pp. 32
Author(s):  
Zahra Parsian ◽  
Farzad Rahmani ◽  
Hassan Soleimanpour
Keyword(s):  
Cardiac Output ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Tracheal Tube ◽  
Standard Method ◽  
Gold Standard ◽  
Direct Visualization ◽  
Gold Standard Method ◽  
Correct Placement

Tracheal intubation and confirming correct placement of tracheal tube is one of the most important subjects in patients who need airway management (1). Gold standard method of confirmation is capnography, but it is just applicable in patients with tangible cardiac output. Other methods of confirming endotracheal intubation such as hearing gurgling sounds in epigastria, auscultation of lungs sounds, esophageal detector device, and chest radiography can be used for this purpose (2). Recently an exact real time, contrary to other methods, method of confirming endotracheal intubation has been developed which is direct visualization of tracheal tube passage through trachea with sonography. Considering the advantages of sonography, it is strongly recommended for the confirmation of endotracheal intubation(3).

Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults

2016 ◽  
Vol 125 (4) ◽  
pp. 656-666 ◽  
Author(s):  
Michael F. Aziz ◽  
Ansgar M. Brambrink ◽  
David W. Healy ◽  
Amy Wen Willett ◽  
Amy Shanks ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Perioperative Outcomes ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Success Rates ◽  
Intubation Success Rate ◽  
Lighted Stylet

Abstract Background Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Methods Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. Results A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope® [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Conclusions Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

scholarly journals Suicidal hanging patient with complete tracheal rupture

2018 ◽  
Vol 26 (2) ◽  
pp. 124-126
Author(s):  
Hyun Ho Jeong ◽  
Kyoung Ho Choi ◽  
Young Min Oh ◽  
Yeon Young Kyong ◽  
Se Min Choi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Tracheal Tube ◽  
Attempted Suicide ◽  
Fiberoptic Intubation ◽  
Tracheal Rupture ◽  
Airway Equipment

In attempted suicide, laryngotracheal rupture caused by hanging leads to rapid death at the scene or before arrival at hospital. The case presented here describes a patient with complete tracheal rupture from an attempted suicidal hanging who was successfully resuscitated. Pre-hospital providers transferred the patient to hospital without being aware of the possibility of airway damage. Cardiac arrest occurred shortly after arrival at hospital. During the cardiopulmonary resuscitation, endotracheal intubation was performed, and fortunately, the tracheal tube was located just below the ruptured trachea and thus enabled ventilation. For patients suspected of having airway damage at the pre-hospital stage, awareness of the patient’s condition and adequate airway management are important. The management of laryngotracheal rupture which suggests that for patients not adequately ventilated, immediate treatment with flexible fiberoptic intubation or tracheostomy is needed to secure the airway. Equipment and personnel at the receiving hospital need to be prepared for immediate treatment.

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