Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

被引:17
作者
Ruetzler, Kurt [1 ]
Smereka, Jacek [2 ]
Abelairas-Gomez, Cristian [3 ,4 ,5 ,6 ]
Frass, Michael [7 ]
Dabrowski, Marek [8 ]
Bialka, Szymon [9 ]
Misiolek, Hanna [9 ]
Plusa, Tadeusz [10 ]
Robak, Oliver [7 ]
Aniolek, Olga [11 ]
Ladny, Jerzy Robert [12 ]
Gorczyca, Damian [11 ]
Ahuja, Sanchit [13 ]
Szarpak, Lukasz [11 ]
机构
[1] Cleveland Clin, Dept Outcomes Res & Gen Anesthesia, Inst Anesthesiol, Cleveland, OH 44106 USA
[2] Wroclaw Med Univ, Dept Emergency Med Serv, Wroclaw, Poland
[3] Univ Santiago de Compostela, CLINURSID Res Grp, Santiago De Compostela, Spain
[4] Univ Santiago de Compostela, Fac Engn, Santiago De Compostela, Spain
[5] Inst Res Santiago IDIS, Santiago De Compostela, Spain
[6] SAMID II Network, Santiago De Compostela, Spain
[7] Med Univ Vienna, Dept Internal Med 1, Vienna, Austria
[8] Poznan Univ Med Sci, Chair & Dept Med Educ, Poznan, Poland
[9] Med Univ Silesia, Div Dent Zabrze, Dept Anaesthesiol & Crit Care, Sch Med, Zabrze, Poland
[10] Lazarski Univ, Med Fac, Warsaw, Poland
[11] Polish Soc Disaster Med, Swieradowska 43 Str, PL-02662 Warsaw, Poland
[12] Med Univ Bialystok, Dept Emergency Med, Bialystok, Poland
[13] Henry Ford Hlth Syst, Dept Anesthesia, Detroit, MI USA
关键词
Airway management; Endotracheal intubation; Medical simulation; Bougie catheter; GUM-ELASTIC BOUGIE; CERVICAL-SPINE; DIRECT LARYNGOSCOPY; BLIND INTUBATION; RECOMMENDATIONS; MANAGEMENT; MANNEQUIN;
D O I
10.1186/s12871-020-01009-7
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. Conclusion In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie.
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页数:10
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