Airway Management When Secretions Obstruct the Larynx, Insertion of a Flexible Bronchoscope
Conditions
Keywords
Flaxible Scope guided intubation, Fibreoptic intubation, The bleeding airway, The difficult airway
Brief summary
The investigators will study to what extent insufflation of oxygen via the suction channel of a flexible bronchoscope can help with making access from the mouth to the trachea easier when there is blood or secretions in the way. We provide the oxygen-flow from the circle-system of an anaesthesia-machine and in this way we can limit the pressure to 30 and 40 cm H2O which are relatively safe pressure-levels. The endoscopy is performed on a plastic manikin and artificial sputum mixed with artificial blood is used. The procedure will be performed by 64 anaesthetists that will be randomised to use either oxygen-insufflation or not. The setup is cross-randomised so that each participant will perform two attempts, one with insufflation and one without. The procedures will be video-taped and evaluated by a blinded observer regarding a) success/failure of advancing the scope to the mid trachea under vision, b) the duration of the procedure. Additionally, subjective scores regarding the benefit of using insufflation will be obtained
Detailed description
The investigators will study to what extent insufflation of oxygen via the suction channel of a flexible bronchoscope can help with making access from the mouth to the trachea easier when there is blood or secretions in the way. We provide the oxygen-flow from the circle-system of an anaesthesia-machine and in this way we can limit the pressure to 30 and 40 cm H2O which are relatively safe pressure-levels. The endoscopy is performed on a plastic manikin and artificial sputum mixed with artificial blood is used. The procedure will be performed by 64 anaesthetists that will be randomised to use either oxygen-insufflation or not. The setup is cross-randomised so that each participant will perform two attempts, one with insufflation and one without. The procedures will be video-taped and evaluated by a blinded observer regarding a) success/failure of advancing the scope to the mid trachea under vision, b) the duration of the procedure. Additionally, subjective scores regarding the benefit of using insufflation will be obtained
Interventions
PROCEDUREaddition of oxygeninsufflation via working channel of flexible scope
addition of oxygeninsufflation via working channel of flexible scope in order to improve visibility when advancing the flexible scope
PROCEDUREno-oxygen insufflation
no-oxygen insufflation added to the flexible scope while advancing it
Sponsors
Rigshospitalet, Denmark
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
one arm is oxygen insufflation first followed by no-insufflation the second arm is: no insufflation followed by oxygen insufflation
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Anesthesiologists attending the airway course Airwaymanagement for Anaesthesiologists \-
Exclusion criteria
* non acceptance of participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The fraction of bronchoscopic advancements that result in a view of vocal cords (Fully or partial) without the view being obstructed by saliva or blood during the advancement | 90 seconds | The fraction in whom The flexible scope is advanced to the trachea with maintained visibility all the time until vocal cord is seen |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration until the tip of the scope is in the trachea | 0-2 minutes | Time from the tip of the scope passes the teeth until it is in the trachea |
| The scope is advanced to the trachea within 2 minutes | 2 minutes | The flexible scope is advanced to the trachea with or without maintained visibility |
| Operation percieved ease of advancing the scope to the trachea with maintained visibility | 2 minutes | Operation percieved ease of advancing the scope to the trachea with maintained visibility, on a visual analogue scale from 1-10, 1 = very easy, 10 = almost impossible, lowest is best |
| Operation percieved ease of advancing the scope to the trachea, overall | 2 minute | Operation percieved ease of advancing the scope to the trachea overall, , on a visual analogue scale from 1-10, 1 = very easy, 10 = almost impossible, lower score is best. |
| The scope is advanced to the trachea within 1 minute | 1 minute | The flexible scope is advanced to the trachea with or without maintained visibility |
| unobstructed advancement to the trachea in 90 seconds | 90 seconds | The flexible scope is advanced to the trachea with maintained visibility |
| Obtaining a view of vocal cord(s) without obstruction of the view, obtained in 30 seconds | 30 sekunds | The fraction of participants in each group who obtain a view of vocal cord(s) without the view being obstructed at any point |
| Obtaining a view of vocal cord(s) without obstruction of the view, obtained in one minute | 1 minute | The fraction of participants in each group who obtain a view of the vocal cord(s) without the view being obstructed at any point |
| Obtaining a view of the vocal cord(s) without obstruction of the view, obtained in 90 seconds | 90 seconds | The fraction of particip in each group who obtain a view of the vocal cord(s) without the view being obstructed, Obtained in 90 seconds |
| The fraction of brochoscopic advancements that results in Unobstructed advancement to the trachea in one minute | 1 minute | The fraction of the attempts when the flexible scope is advanced to the trachea with maintained visibility |
| unobstructed advancement to the trachea in two minutes | 2 minute | The flexible scope is advanced to the trachea with maintained visibility |
Other
| Measure | Time frame | Description |
|---|---|---|
| Operator pecieved benefit of the addition of oxygen insufflation | 2 minutes | After having tried the technique, the operator answers the question: How do you find that the addition of oxygen affects the advancement of the scope to the trachea? The aswer is on a VAS (Visual Analogue Scale) sale form -5 = It makes it much worse via 0 = neutral to +5 (it makes it much better), higher is best |
Countries
Denmark
Contacts
Primary ContactMichael S Kristensen, MD
Outcome results
None listed