Airway Management, Fiberoptic Guided Intubation, Patient Experience
Conditions
Keywords
airway management, flexible endoscopy guided intubation, patient discomfort
Brief summary
Airway management problems are key drivers for anesthesia-related adverse events. Awake tracheal intubation using flexible bronchoscopy and preserved spontaneous breathing (ATI:FB) is a recommended technique to manage difficult tracheal intubation in anaesthesia, intensive care and emergency medicine. ATI:FB is regarded as the gold standard of tracheal intubation in many scenarios, however there is insufficient data on the patients experience while undergoing this form of airway management. ATI:FB can be facilitated using either a transnasal or transoral route. The study aims to compare patient-centred and operator-focused outcome parameters between these two different approaches with a focus on patient discomfort.
Interventions
None listed
Sponsors
Universitätsklinikum Hamburg-Eppendorf
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients scheduled for surgery requiring tracheal intubation * patients with an anticipated difficult airway requiring ATI:FB * consent by the patient * minimum 18 years of age
Exclusion criteria
* patients scheduled for surgery requiring tracheal intubation * patients not scheduled for ATI:FB * pregnant or breastfeeding patients * consent withheld or not possible to obtain by the patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient reported discomfort experienced during ATI:FB | 24 hours after anaesthesia | recorded on a visual analog scale (1-100; lower values better) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Conversion to another type of airway management | 1 hour | Observed during airway management |
| Percentage of glottic opening | 1 hour | Grading of the best view obtained during laryngoscopy (%) |
| Glottic view | 1 hour | Grading of the best view obtained using landmarks (6 stages) |
| Time to best glottic view | 1 hour | Recorded during airway management |
| Patient reported recall of the ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported pain experienced during ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported fear experienced during ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported feeling of suffocation experienced during ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported dyspnea experienced during ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported distress experienced during ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported coughing experienced after ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported dry throat experienced after ATI:FB? | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported hoarseness experienced after ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported sleeping problems experienced after ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported occurrence of nightmares experienced after ATI:FB | 24 hours after airway management | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported preoperative expectation of discomfort to be experienced during ATI:FB | during preoperative assessment | yes/no and on a visual analog scale (1-100; lower values better) |
| Patient reported preoperative fear of airway management | during preoperative assessment | yes/no and on a visual analog scale (1-100; lower values better) |
| First attempt success | 1 hour | number of participants with successful ATI:FB with only one attempt |
| Conversion from transnasal to transoral bronchoscopy or vice versa | 1 hour | Observed during airway management |
| Number of intubation attempts | 1 hour | Observed during airway management |
| Successful ATI:FB | 1 hour | Number of participants with successful ATI:FB |
| Successful bronchoscopy | 1 hour | Number of participants with successful bronchoscopy |
| Successful tube placement | 1 hour | Number of participants with successful tracheal tube placement |
| Time to intubation | 1 hour | Recorded during airway management |
| Lowest oxygen saturation | 1 hour | Measured during airway management (%) |
| Endtidal CO2 | 1 hour | First value measured after intubation in mmHg |
| Airway obstructions requiring external manipulation | 1 hour | yes/no |
| Hypoxia | 1 hour | Lowest peripheral oxygen saturation measured by pulsoximetry in % |
| Cardiovascular event requiring intervention (hypotension/bradycardia) | 1 hour | Observed during airway management |
| Cardiovascular event requiring intervention (hypertension, tachycardia) | 1 hour | Observed during airway management |
| Additional manoeuvres and adjuncts | 1 hour | Observed during airway management |
| Airway-related complications | 1 hour | Recorded during airway management |
| Anaesthesia alert card issue | 1 hour | Recorded after airway management |
| Recommendation for future airway management | 1 hour | Recorded after airway management |
| Richmond Agitation-Sedation Scale | 1 hour | Observed during airway management (-5 to 4; lower values indicate deeper sedation) |
| Subjective reporting of difficulty of sedation, topicalisation, bronchoscopy and tube placement | 1 hour | On a visual analog scale (1-100) |
| Preparation time | 1 hour | Recorded during airway management |
| Number of bronchoscopy attempts | 1 hour | Observed during airway management |
Countries
Germany
Outcome results
None listed