The use of combined laryngo-bronchoscopy approach for difficult airways: a pilot simulation study [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-99234

The use of combined laryngo-bronchoscopy approach for difficult airways: a pilot simulation study

Filippo Sanfilippo1, Francesco Sgalambro2, Giuseppe Chiaramonte3, Cristina Santonocito1, Gaetano Burgio1, Antonio Arcadipane1
1Department Of Anesthesia And Intensive Care, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy
2Department Of Anesthesia And Intensive Care, Istituto Oncologico Del Mediterraneo (iom), Via Penninazzo 7, 95029 Viagrande (ct), Italy
3”renato Fiandaca” Simulation Center, Irccs-ismett (istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione), Palermo, Italy

Objective: Several airway devices are available for difficult tracheal intubation (DTI), but failure rates remains high. The combination of laryngoscopy to aid fiberoptic-bronchoscope intubation (CLBI) has been increasingly reported in DTI situations, but not formally studied yet.
Methods: We designed a single-center simulation study on DTI (neck rigidity and tongue edema) comparing three techniques: direct laryngoscopy (DL), video-laryngoscopy (VLS) and CLBI. Eighteen anesthesiologists naïve to VLS/CLBI approaches participated. Primary outcome was intubation rate at 1st attempt. Secondary outcomes were: overall time-to-intubate (TTI) and time-to-ventilate (TTV), success at 2nd and 3rd attempt, ease of intubation as evaluated by a subjective 5-point Likert scale.
Results: The CLBI technique had higher success at 1st attempt than DL (66% vs 22%, p=0.007), while VLS did not (44%, p=0.16). A trend towards higher success at 3rd attempt was found for both VLS and CLBI vs DL (p=0.07 and p=0.06, respectively). The VLS had shorter overall TTV than DL (88±60 vs 121±59 sec respectively, p=0.04) and a trend towards shorter TTI (81±61 vs 116±64 sec respectively, p=0.06). The CLBI approach showed non-significantly lower TTI/TTV as compared to the DL (p=0.10 and p=0.16, respectively). Anesthesiologists judged intubation with VLS (3.7±1.0) and CLBI (3.8±1.0) easier than DL (1.7±0.8, both p<0.001).
Conclusion: In a simulated DTI scenario, CLBI had higher success rate at 1st attempt than DL, while VLS did not. By the 3rd attempt, both rescue techniques had a trend towards higher success rate than DL. The CLBI technique seems a promising alternative for the management of DTI.

Keywords: difficult tracheal intubation, fiberoptic intubation, videolaryngoscope, manikin, tongue edema.




Corresponding Author: Filippo Sanfilippo, Italy


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