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.
Study Type
OBSERVATIONAL
Enrollment
198
University Medical Center Hamburg-Eppendorf
Hamburg, Hamburg, Germany
RECRUITINGPatient reported discomfort experienced during ATI:FB
recorded on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after anaesthesia
Patient reported recall of the ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported pain experienced during ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported fear experienced during ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported feeling of suffocation experienced during ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported dyspnea experienced during ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported distress experienced during ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported coughing experienced after ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported dry throat experienced after ATI:FB?
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported hoarseness experienced after ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported sleeping problems experienced after ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported occurrence of nightmares experienced after ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: 24 hours after airway management
Patient reported preoperative expectation of discomfort to be experienced during ATI:FB
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: during preoperative assessment
Patient reported preoperative fear of airway management
yes/no and on a visual analog scale (1-100; lower values better)
Time frame: during preoperative assessment
First attempt success
number of participants with successful ATI:FB with only one attempt
Time frame: 1 hour
Number of bronchoscopy attempts
Observed during airway management
Time frame: 1 hour
Number of intubation attempts
Observed during airway management
Time frame: 1 hour
Successful ATI:FB
Number of participants with successful ATI:FB
Time frame: 1 hour
Successful bronchoscopy
Number of participants with successful bronchoscopy
Time frame: 1 hour
Successful tube placement
Number of participants with successful tracheal tube placement
Time frame: 1 hour
Conversion from transnasal to transoral bronchoscopy or vice versa
Observed during airway management
Time frame: 1 hour
Conversion to another type of airway management
Observed during airway management
Time frame: 1 hour
Percentage of glottic opening
Grading of the best view obtained during laryngoscopy (%)
Time frame: 1 hour
Glottic view
Grading of the best view obtained using landmarks (6 stages)
Time frame: 1 hour
Time to best glottic view
Recorded during airway management
Time frame: 1 hour
Time to intubation
Recorded during airway management
Time frame: 1 hour
Lowest oxygen saturation
Measured during airway management (%)
Time frame: 1 hour
Endtidal CO2
First value measured after intubation in mmHg
Time frame: 1 hour
Airway obstructions requiring external manipulation
yes/no
Time frame: 1 hour
Hypoxia
Lowest peripheral oxygen saturation measured by pulsoximetry in %
Time frame: 1 hour
Cardiovascular event requiring intervention (hypotension/bradycardia)
Observed during airway management
Time frame: 1 hour
Cardiovascular event requiring intervention (hypertension, tachycardia)
Observed during airway management
Time frame: 1 hour
Additional manoeuvres and adjuncts
Observed during airway management
Time frame: 1 hour
Airway-related complications
Recorded during airway management
Time frame: 1 hour
Anaesthesia alert card issue
Recorded after airway management
Time frame: 1 hour
Recommendation for future airway management
Recorded after airway management
Time frame: 1 hour
Richmond Agitation-Sedation Scale
Observed during airway management (-5 to 4; lower values indicate deeper sedation)
Time frame: 1 hour
Subjective reporting of difficulty of sedation, topicalisation, bronchoscopy and tube placement
On a visual analog scale (1-100)
Time frame: 1 hour
Preparation time
Recorded during airway management
Time frame: 1 hour
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