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Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit.

ABSTRACT: This case report describes a patient in the ICU in need of urgent intubation, for whom video laryngoscope-guided intubation had previously failed. The Infrared Red Intubation System (IRRIS) may enhance the chance of successful flexible bronchoscope intubation, especially when performed by non-expert anesthesiologists.

SUBMITTER: Hannig KE

PROVIDER: S-EPMC9010598 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit.

Hannig Kjartan Eskjaer KE Kristensen Michael Seltz MS Hauritz Rasmus Wulff RW Jessen Christian C Grejs Anders Morten AM

Clinical case reports 20220414 4

This case report describes a patient in the ICU in need of urgent intubation, for whom video laryngoscope-guided intubation had previously failed. The <i>Infrared Red Intubation System (IRRIS)</i> may enhance the chance of successful flexible bronchoscope intubation, especially when performed by non-expert anesthesiologists. ...[more]

PMID: 35441029

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Project description:BackgroundEndotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency.MethodsThis study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation.ResultsTrainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation.ConclusionsLearning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees.Trial registrationTrial registration: Chinese Clinical Trial Register, ChiCTR 2000032166.

Dataset Information

Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit.

Publications

Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit.

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