Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-99234 | DOI: 10.5152/TJAR.2019.99234  

Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study

Filippo Sanfilippo1, Francesco Sgalambro2, Giuseppe Chiaramonte3, Cristina Santonocito1, Gaetano Burgio1, Antonio Arcadipane1
1Department of Anaesthesia and Intensive Care, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy
2Department of Anaesthesia and Intensive Care, Istituto Oncologico Del Mediterraneo (iom), Viagrande, Italy
3“renato Fiandaca” Simulation Center, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy

Objective: There are several airway devices available for difficult tracheal intubation (DTI) management, but the failure rate remains high. The use of laryngoscopy to facilitate the fibreoptic-bronchoscope intubation (CLBI) has been increasingly reported in DTI situations, but it has not been formally studied yet.
Methods: We designed a single-centre simulation study on DTI (neck rigidity and tongue oedema) comparing three techniques: direct laryngoscopy (DL), video-laryngoscopy (VLS) and CLBI. Eighteen anaesthesiologists naïve to VLS/CLBI approaches, participated in the study. The primary outcome was the intubation rate at the first attempt. Secondary outcomes were an overall time-to-intubate (TTI) and time-to-ventilate (TTV), success at the second and third attempt and ease of intubation as evaluated by a subjective 5-point Likert scale.
Results: The CLBI technique had a higher success rate at the first attempt than DL (66% vs 22%, p=0.007), while VLS did not (44%, p=0.16). A trend towards higher success at the third attempt was found for both VLS and CLBI vs DL (p=0.07 and p=0.06, respectively). The VLS had a shorter overall TTV than DL (88±60 vs 121±59 sec, respectively, p=0.04) and a trend towards a shorter TTI (81±61 vs 116±64 sec, respectively, p=0.06). The CLBI approach showed a non-significantly lower TTI/TTV as compared to DL (p=0.10 and p=0.16, respectively). Anaesthesiologists judged that the intubation with VLS (3.7±1.0) and CLBI (3.8±1.0) was easier than with DL (1.7±0.8, both p<0.001).
Conclusion: In a simulated DTI scenario, CLBI had a higher success rate at the first attempt than DL, while VLS did not. By the third attempt, both rescue techniques had a trend towards a higher success rate than DL. The CLBI technique seems a promising alternative for the management of DTI.

Keywords: Difficult tracheal intubation, fibreoptic intubation, manikin, tongue oedema, video-laryngoscope




Corresponding Author: Filippo Sanfilippo, Italy


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