ABSTRACT
Objetivos. El objetivo principal fue describir el grado de percepción sobre el conocimiento, las habilidades y la seguridad antes y después de un programa de entrenamiento con videolaringoscopia y mecanismo de protección Intubox® en el manejo de la vía aérea de pacientes con COVID-19. El objetivo secundario fue evaluar la seguridad de los dispositivos de barrera en la intubación a través de un análisis visual de dispersión de partículas.Método. Ensayo clínico de un solo brazo basado en simulación. Los participantes fueron médicos que realizaron un programa de formación mediante simulación clínica de baja y alta fidelidad. Se usó un instrumento diseñado y valida-do específico para evaluar la percepción sobre el conocimiento, las habilidades y la seguridad antes y después del programa. Se realizó un análisis visual de la contaminación por gotas.Resultados. La muestra final estuvo compuesta por 27 médicos, con una edad media de 40 (DE 10,8) años y el 63% mujeres. Se obtuvo un incremento estadísticamente significativo en las dimensiones conocimiento, habilidad y seguridad tras el entrenamiento. Se observó una menor contaminación cuando se realizaron las técnicas de manejo de vía aérea con urna protectora.Conclusiones. Los urgenciólogos incrementaron su percepción sobre los conocimientos, habilidades y seguridad en el manejo de la vía aérea en pacientes con COVID-19 tras un programa de formación con simulación. El uso combinado de laringoscopia y dispositivo de barrera Intubox® causó menor dispersión de partículas durante la intubación. (AU)
Objectives. The main objective was to describe physicians perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation.Methods. Single-arm clinical simulation trial. The participants were physicians who received training in both a low-fidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually.Results. Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place.Conclusions. After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Airway Management/methods , Laryngoscopy/education , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Education, Medical, Continuing/methods , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , PandemicsABSTRACT
OBJECTIVES: The main objective was to describe physicians' perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation. MATERIAL AND METHODS: Single-arm clinical simulation trial. The participants were physicians who received training in both a lowfidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually. RESULTS: Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place. CONCLUSION: After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation.
OBJETIVO: El objetivo principal fue describir el grado de percepción sobre el conocimiento, las habilidades y la seguridad antes y después de un programa de entrenamiento con videolaringoscopia y mecanismo de protección Intubox® en el manejo de la vía aérea de pacientes con COVID-19. El objetivo secundario fue evaluar la seguridad de los dispositivos de barrera en la intubación a través de un análisis visual de dispersión de partículas. METODO: Ensayo clínico de un solo brazo basado en simulación. Los participantes fueron médicos que realizaron un programa de formación mediante simulación clínica de baja y alta fidelidad. Se usó un instrumento diseñado y validado específico para evaluar la percepción sobre el conocimiento, las habilidades y la seguridad antes y después del programa. Se realizó un análisis visual de la contaminación por gotas. RESULTADOS: La muestra final estuvo compuesta por 27 médicos, con una edad media de 40 (DE 10,8) años y el 63% mujeres. Se obtuvo un incremento estadísticamente significativo en las dimensiones conocimiento, habilidad y seguridad tras el entrenamiento. Se observó una menor contaminación cuando se realizaron las técnicas de manejo de vía aérea con urna protectora. CONCLUSIONES: Los urgenciólogos incrementaron su percepción sobre los conocimientos, habilidades y seguridad en el manejo de la vía aérea en pacientes con COVID-19 tras un programa de formación con simulación. El uso combinado de laringoscopia y dispositivo de barrera Intubox® causó menor dispersión de partículas durante la intubación.
Subject(s)
Airway Management/methods , COVID-19/therapy , Clinical Competence , Education, Medical, Continuing/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Laryngoscopy/education , Adult , Airway Management/instrumentation , COVID-19/prevention & control , COVID-19/transmission , Female , Humans , Laryngoscopy/instrumentation , Laryngoscopy/methods , Male , Middle Aged , Patient Safety , Perception , Self Efficacy , Video RecordingABSTRACT
Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent® tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL® in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy.
Subject(s)
Airway Management , Postoperative Complications/therapy , Thoracic Surgical Procedures , Tracheal Stenosis/therapy , Tracheostomy , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: In 2003 a simple test to detect difficult intubation (DI) in patients underwent laryngeal microsurgery was described. The present study was conducted to validate the test. METHODS: Patients with laryngeal disease scheduled for laryngeal microsurgery were included. The variables evaluated were eleven parameters: Mallampati Score ≥III, thyromental distance <6.5cm, mouth opening <40mm, limitation of the temporomandibular joint, pathological dentition, arched paladet, maxillary deficiency, neck mobility <90°, body mass index, symptoms of laryngeal dysfunction, and tumour of supraglottic region. A rapid examination of the airway by an expert anaesthesiologist was carried out just before induction. DI was defined by a Cormack laryngeal view gradeiii-iv and/or if auxiliary equipment was required to achieve orotracheal intubation. A comparison of ROC curves was conducted to estimate the best predicting cut-off, as well as differences between the index described in 2003 and the rapid assessment by an expert anaesthesiologist. RESULTS: One hundred and five patients were included in the study. The incidence of DI according to the predefined criteria was 45% (47 patients). The score at the cut-off of 5 provides a sensitivity of 89% and a specificity of 55%. The fast-evaluation by an expert anaesthesiologist obtained similar sensitivity (89%) and better specificity (81%). Area under curve (AUC) was 0.87, similar to a fast evaluation (AUC: 0.85; P=.71). CONCLUSION: The index was validated at a cut-off of ≥5, being a useful and reliable test to predict DI in patients with laryngeal diseases and it is a useful tool for anaesthesiologists with conventional training.
Subject(s)
Airway Management/methods , Airway Obstruction/diagnosis , Anthropometry/methods , Intubation, Intratracheal , Larynx/surgery , Microsurgery , Severity of Illness Index , Adult , Area Under Curve , Humans , Laryngoscopy , Physical Examination , ROC Curve , Risk Assessment , Sensitivity and SpecificityABSTRACT
OBJECTIVE: The aim of this observational prospective study was to evaluate the usefulness of TruviewPCD for tracheal intubation in clinical practice, and to provide data for future studies. MATERIAL AND METHOD: A study was conducted on 86 consecutive children undergoing ear, nose and throat (ENT) or paediatric procedures under general anaesthesia with tracheal intubation. Children with two or more difficult airway criteria were excluded. A descriptive statistical analysis was performed. RESULTS: Eighty-three patients were successfully intubated with TruviewPCD. Demographic data: Age 4.9 (2.8) years, weight 19.5 (7.7)kg. Seventy-nine children needed one attempt and four required two attempts at intubation. Time for glottis view and tracheal intubation was 10.8 (5.6) and 30 [27.9-37] seconds, respectively. Eighty-one patients were classified as easy or very easy to intubate, and only two cases were considered difficult. No significant complications were registered. CONCLUSIONS: TruviewPCD is a good device for paediatric airway management. It would be interesting to have an intermediate blade between size 1 and 2, as the difference between both is too wide.
Subject(s)
Anesthesia, General , Intubation, Intratracheal , Laryngoscopes , Airway Management , Child , Child, Preschool , Female , Humans , Male , Prospective Studies , Video RecordingABSTRACT
Difficult airway is a life-threatening situation which compromises the permeability of the upper airway and thus adequate ventilation and oxygenation. Multiple factors, acute and chronic such as: infectious, neoplastic and trauma have been associated with critical airway. Morbidity and mortality related to a difficult airway management remains as a significant problem in children, so is essential for the pediatric health team to be trained to recognize and anticipate situations that in clinical practice might determine a critical airway. The aim of this review is to provide concepts and guidance to assess patients with potentially difficult airway.
Una vía aérea difícil condiciona una situación con riesgo vital, ya que pone en peligro la permeabilidad de la vía aérea superior y con esto la capacidad de mantener una adecuada ventilación y oxigenación. Múltiples factores, tanto agudos como crónicos, entre ellos factores anatómicos propios del niño/a, complicaciones infecciosas, neoplásicas y/o traumáticas se han asociado con una vía aérea crítica. La morbilidad y mortalidad asociada al manejo inadecuado de esta condición continua siendo un problema significativo en la edad pediátrica; siendo fundamental que el equipo de salud se encuentre entrenado en reconocer y anticipar situaciones que en la práctica clínica podrían asociarse con una vía aérea difícil o crítica. El objetivo de la presente revisión es otorgar conceptos y una orientación en el enfrentamiento de los pacientes con una vía aérea potencialmente difícil.
