Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study

被引：2

作者：

Karamchandani, Kunal ^{[64
,1
]}

Nasa, Prashant ^{[2
,3
]}

Jarzebowski, Mary ^{[4
]}

Brewster, David J. ^{[5
,55
]}

De Jong, Audrey ^{[6
]}

Bauer, Philippe R. ^{[7
]}

Berkow, Lauren ^{[8
]}

Brown, Calvin A., III ^{[9
]}

Cabrini, Luca ^{[10
]}

Casey, Jonathan ^{[11
]}

Cook, Tim ^{[12
]}

Divatia, Jigeeshu Vasishtha ^{[13
]}

Duggan, Laura V. ^{[14
]}

Ellard, Louise ^{[15
]}

Ergan, Begum ^{[16
]}

Fagerlund, Malin Jonsson ^{[17
,18
]}

Gatward, Jonathan ^{[19
,20
]}

Greif, Robert ^{[21
,22
]}

Higgs, Andy ^{[23
]}

Jaber, Samir ^{[6
]}

Janz, David ^{[24
]}

Joffe, Aaron M. ^{[25
]}

Jung, Boris ^{[26
]}

Kovacs, George ^{[27
,28
,29
,30
]}

Kwizera, Arthur ^{[31
]}

Laffey, John G. ^{[32
,33
]}

Lascarrou, Jean-Baptiste ^{[34
]}

Law, J. Adam ^{[35
]}

Marshall, Stuart ^{[36
,37
]}

McGrath, Brendan A. ^{[38
]}

Mosier, Jarrod M. ^{[39
]}

Perin, Daniel ^{[40
]}

Roca, Oriol ^{[41
,42
,43
]}

Rolle, Amelie ^{[44
]}

Russotto, Vincenzo ^{[45
]}

Sakles, John C. ^{[46
]}

Shrestha, Gentle S. ^{[47
]}

Smischney, Nathan J. ^{[48
]}

Sorbello, Massimiliano ^{[49
,50
]}

Tung, Avery ^{[51
]}

Jabaley, Craig S. ^{[52
,53
]}

Myatra, Sheila Nainan ^{[54
]}

机构：

[1] Univ Texas Southwestern Med Ctr, Dept Anesthesiol & Pain Management, Dallas, TX 75390 USA

[2] NMC Specialty Hosp, Crit Care Med, Dubai, U Arab Emirates

[3] Coll Med & Hlth Sci, Internal Med, Al Ain, Abu Dhabi, U Arab Emirates

[4] Henry Ford Hlth, Dept Anesthesiol Pain Management & Perioperat Med, Detroit, MI USA

[5] Cabrini Hosp, Intens Care Unit, Melbourne, Australia

[6] Univ Montpellier, Reg Univ Hosp Montpellier, Dept Anesthesia & Intens Care Unit,Inserm, St Eloi Hosp,Phymedexp,CNRS,CHRU Montpellier, Montpellier, France

[7] Mayo Clin, Mayo Clin Coll Med & Sci, Div Pulm & Crit Care Med, Rochester, MN USA

[8] Univ Florida, Coll Med, Dept Anesthesiol, Gainesville, FL USA

[9] UMass Chan Lahey Sch Med, Lahey Hosp & Med Ctr, Dept Emergency Med, Burlington, MA USA

[10] Insubria Univ, Osped Circolo, Dept Biotechnol & Life Sci, Varese, Italy

[11] Vanderbilt Univ, Med Ctr, Div Pulm & Crit Care Med, Nashville, TN USA

[12] Royal United Hosp Bath NHS Fdn Trust, Dept Anaesthesia & Intens Care Med, Bath, England

[13] Tata Mem Hosp, Homi Bhabha Natl Inst, Dept Anaesthesiol Crit Care & Pain, Mumbai, Maharashtra, India

[14] Univ Ottawa, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada

[15] Univ Melbourne, Dept Crit Care, Dept Anaesthesia, Austin Hlth, Melbourne, Vic, Australia

[16] Dokuz Eylul Univ, Div Pediat Crit Care Med, Izmir, Turkiye

[17] Karolinska Univ Hosp Solna, Dept Perioperat Med & Intens Care, Dept Physiol & Pharmacol, Stockholm, Sweden

[18] Karolinska Inst, Stockholm, Sweden

[19] Royal North Shore Hosp, Intens Care Unit, Sydney, Australia

[20] Univ Sydney, Sydney Med Sch, Sydney, Australia

[21] Univ Bern, Bern, Switzerland

[22] Univ Turin, Dept Surg Sci, Turin, Italy

[23] Warrington Teaching Hosp, Dept Crit Care Med, Warrington, Cheshire, England

[24] Univ Med Ctr New Orleans, LSU Sch Med New Orleans, Tulane Sch Med, Sect Pulm & Crit Care Med, New Orleans, LA USA

[25] Creighton Univ, Sch Med, Valleywise Hlth Med Ctr, Dept Anesthesiol, Phoenix, AZ USA

[26] Montpellier Univ, Med Intens Care Unit, INSERM PhyMedexp, Montpellier, France

[27] Dalhousie Univ, Charles V Keating Emergency & Trauma Ctr, Dept Emergency Med, Halifax, NS, Canada

[28] Dalhousie Univ, Charles V Keating Emergency & Trauma Ctr, Dept Anaesthesia, Halifax, NS, Canada

[29] Dalhousie Univ, Charles V Keating Emergency & Trauma Ctr, Dept Med Neurosci & Continuing Profess Dev, Halifax, NS, Canada

[30] Dalhousie Univ, Charles V Keating Emergency & Trauma Ctr, Dept Med Educ, Halifax, NS, Canada

[31] Makerere Univ, Mulago Hosp Complex, Dept Anaesthesia & Crit Care, Coll Hlth Sci, Kampala, Uganda

[32] Galway Univ Hosp, Saolta Hosp Grp, Dept Anaesthesia & Intens Care Med, Galway, Ireland

[33] Univ Galway, Sch Med, Anaesthesia & Intens Care Med, Galway, Ireland

[34] Nantes Univ, CHU Nantes, Movement Interact Performance MIP, UR 4334,Med Intens Reanimat, F-44000 Nantes, France

[35] Dalhousie Univ, Fac Med, Dept Anesthesia Pain Management & Perioperat Med, Halifax, NS, Canada

[36] Univ Melbourne, Dept Crit Care, Melbourne, Australia

[37] Monash Univ, Anaesthesia & Perioperat Med, Melbourne, Australia

[38] Manchester Univ Hosp NHS Fdn Trust, Anaesthesia & Intens Care Med, Manchester, England

[39] Univ Arizona, Coll Med, Dept Emergency Med, Div Pulm Allergy Crit Care & Sleep,Dept Med, Tucson, AZ USA

[40] Albert Einstein Hosp, Sao Paulo, Brazil

[41] Parc Tauli Hosp Univ, Inst Recerca Part Tauli I3PT CERCA, Serv Med Intens, Sabadell, Spain

[42] Univ Autonoma Barcelona, Dept Med, Bellaterra, Spain

[43] Inst Salud Carlos III, Ciber Enfermedades Resp Ciberes, Madrid, Spain

[44] Univ Les Antilles, Univ Hosp La Guadeloupe, Anesthesiol & Intens Care, Les Abymes, France

[45] Univ Turin, Univ Hosp San Luigi Gonzaga, Anesthesia & Intens Care, Turin, TO, Italy

[46] Univ Arizona, Coll Med, Dept Emergency Med, Tucson, AZ USA

[47] Tribhuvan Univ, Dept Crit Care Med, Teaching Hosp, Kathmandu, Nepal

[48] Mayo Clin, Dept Anesthesiol & Crit Care Med, Rochester, MN USA

[49] PO Giovanni Paolo II, UOC Anesthesia & Intens Care, Ragusa, Italy

[50] Kore Univ, Anaesthesia & Intens Care, Enna, Italy

来源：

INTENSIVE CARE MEDICINE | 2024年

关键词：

Tracheal intubation; Delphi; Physiologically difficult airway; Airway management; Intubation; Intratracheal/adverse effects; Guidelines; Intratracheal/methods; RAPID-SEQUENCE INTUBATION; INTENSIVE-CARE-UNIT; NATIONAL AUDIT PROJECT; ENDOTRACHEAL INTUBATION; NONINVASIVE VENTILATION; MAJOR COMPLICATIONS; NONTECHNICAL SKILLS; PREVENT AWARENESS; RANDOMIZED-TRIAL; ROYAL-COLLEGE;

D O I：

10.1007/s00134-024-07578-2

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

PurposeOur study aimed to provide consensus and expert clinical practice statements related to airway management in critically ill adults with a physiologically difficult airway (PDA).MethodsAn international Steering Committee involving seven intensivists and one Delphi methodology expert was convened by the Society of Critical Care Anaesthesiologists (SOCCA) Physiologically Difficult Airway Task Force. The committee selected an international panel of 35 expert clinician-researchers with expertise in airway management in critically ill adults. A Delphi process based on an iterative approach was used to obtain the final consensus statements.ResultsThe Delphi process included seven survey rounds. A stable consensus was achieved for 53 (87%) out of 61 statements. The experts agreed that in addition to pathophysiological conditions, physiological alterations associated with pregnancy and obesity also constitute a physiologically difficult airway. They suggested having an intubation team consisting of at least three healthcare providers including two airway operators, implementing an appropriately designed checklist, and optimizing hemodynamics prior to tracheal intubation. Similarly, the experts agreed on the head elevated laryngoscopic position, routine use of videolaryngoscopy during the first attempt, preoxygenation with non-invasive ventilation, careful mask ventilation during the apneic phase, and attention to cardiorespiratory status for post-intubation care.ConclusionUsing a Delphi method, agreement among a panel of international experts was reached for 53 statements providing guidance to clinicians worldwide on safe tracheal intubation practices in patients with a physiologically difficult airway to help improve patient outcomes. Well-designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.

引用

页码：1563 / 1579

页数：17

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