Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

被引:318
作者
Ahmad, I. [1 ,2 ]
El-Boghdadly, K. [1 ,2 ]
Bhagrath, R. [3 ]
Hodzovic, I. [4 ,5 ]
McNarry, A. F. [6 ]
Mir, F. [7 ]
O'Sullivan, E. P. [8 ]
Patel, A. [9 ,10 ]
Stacey, M. [11 ]
Vaughan, D. [12 ]
机构
[1] Guys & St Thomas NHS Fdn Trust, Dept Anaesthesia, London, England
[2] Kings Coll London, London, England
[3] Barts Hlth NHS Trust, Dept Anaesthesia, London, England
[4] Cardiff Univ, Sch Med, Dept Anaesthesia, Cardiff, S Glam, Wales
[5] Aneurin Bevan Univ Hlth Board, Dept Anaesthesia, Newport, Gwent, Wales
[6] NHS Lothian, Dept Anaesthesia, Edinburgh, Midlothian, Scotland
[7] St Georges Univ Hosp NHS Fdn Trust, Dept Anaesthesia, London, England
[8] St James Hosp, Dept Anaesthesia, Dublin, Ireland
[9] Royal Natl Throat Nose & Ear Hosp, Dept Anaesthesia, London, England
[10] Univ Coll London Hosp NHS Fdn Trust, London, England
[11] Cardiff & Vale NHS Trust HEIW, Dept Anaesthesia, Cardiff, S Glam, Wales
[12] Northwick Pk Hosp & Clin Res Ctr, Dept Anaesthesia, London, England
关键词
airway management; bronchoscopy; laryngoscopy; tracheal intubation; training; videolaryngoscopy; FIBEROPTIC OROTRACHEAL INTUBATION; DEPARTMENT PROCEDURAL SEDATION; ASSOCIATION; 2016; GUIDELINES; RANDOMIZED-CONTROLLED-TRIAL; LARYNGEAL MASK AIRWAY; FLEX-TIP TUBE; LOCAL-ANESTHESIA; SUPPLEMENTAL OXYGEN; ATOMIZED LIDOCAINE; OBESE-PATIENT;
D O I
10.1111/anae.14904
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high-quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post-tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.
引用
收藏
页码:509 / 528
页数:20
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