Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study
Background: The swapping of a supraglottic airway device or a tracheal tube in anaesthetised adult patients is a challenging procedure because potential complications through hypoxemia and loss of airway may occur, with life-threatening implications. This study aims to evaluate which airway techniqu...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/1/16 |
| _version_ | 1797358572415221760 |
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| author | Marc Kriege Tim Demare Robert Ruemmler Irene Schmidtmann Janosh Wojciechowski Anneke Busch Thomas Ott |
| author_facet | Marc Kriege Tim Demare Robert Ruemmler Irene Schmidtmann Janosh Wojciechowski Anneke Busch Thomas Ott |
| author_sort | Marc Kriege |
| collection | DOAJ |
| description | Background: The swapping of a supraglottic airway device or a tracheal tube in anaesthetised adult patients is a challenging procedure because potential complications through hypoxemia and loss of airway may occur, with life-threatening implications. This study aims to evaluate which airway technique offers the highest success rate concerning a secure airway in established supraglottic airway and tracheal tube airway exchange scenarios. Methods: After ethical approval, anaesthesiologists were randomised 1:1 into simulated scenarios: an LTS group (malpositioned laryngeal tube) and a Cuff group (relevant cuff leakage of a placed tracheal tube). After that, both groups completed a common scenario consisting of a partially obstructed tracheal tube lumen in a fixed prone position with a Mayfield clamp. The primary endpoint was a successful tracheal airway exchange within ten minutes after the start of the scenario and before severe hypoxemia (SpO<sub>2</sub> < 80%) arose. Secondary endpoints were the evaluation of factors influencing success after 10 min. Results: In total, 60 anaesthesiologists (LTS group <i>n</i> = 30; Cuff group <i>n</i> = 30) with a median experience of 7 years (IQR 4-11) were observed. Within 10 min, a malpositioned laryngeal tube was successfully exchanged by 27/30 (90%) participants, compared to the exchange of a tracheal tube with a relevant cuff leakage by 29/30 (97%; <i>p</i> > 0.05). An airway exchange in an obstructed tube scenario occurred in 22/59 (37%). Loss of airway maintenance showed an obvious association with failure in the common scenario (<i>p</i> = 0.02). Conclusion: The results of this simulation-based study reflect that the exchange of an existing but insufficient airway device in clinical practice is a high-risk procedure. Especially in a fixed prone position, the deliberate evaluation of the existing airway patency and well-conceived airway management in the case of the accidental loss of the airway or obstructed airway access are crucial. |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T15:03:57Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0a9c1c9ca91c400a9cb11f46986c06192024-01-10T15:00:39ZengMDPI AGJournal of Clinical Medicine2077-03832023-12-011311610.3390/jcm13010016Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled StudyMarc Kriege0Tim Demare1Robert Ruemmler2Irene Schmidtmann3Janosh Wojciechowski4Anneke Busch5Thomas Ott6Department of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, GermanyDepartment of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, GermanyDepartment of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, GermanyInstitute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, GermanyDepartment of Anaesthesiology and Intensive Care, Asklepios Paulinen Hospital Wiesbaden, 65197 Wiesbaden, GermanyDepartment of Anaesthesiology and Intensive Care, Asklepios Paulinen Hospital Wiesbaden, 65197 Wiesbaden, GermanyDepartment of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, GermanyBackground: The swapping of a supraglottic airway device or a tracheal tube in anaesthetised adult patients is a challenging procedure because potential complications through hypoxemia and loss of airway may occur, with life-threatening implications. This study aims to evaluate which airway technique offers the highest success rate concerning a secure airway in established supraglottic airway and tracheal tube airway exchange scenarios. Methods: After ethical approval, anaesthesiologists were randomised 1:1 into simulated scenarios: an LTS group (malpositioned laryngeal tube) and a Cuff group (relevant cuff leakage of a placed tracheal tube). After that, both groups completed a common scenario consisting of a partially obstructed tracheal tube lumen in a fixed prone position with a Mayfield clamp. The primary endpoint was a successful tracheal airway exchange within ten minutes after the start of the scenario and before severe hypoxemia (SpO<sub>2</sub> < 80%) arose. Secondary endpoints were the evaluation of factors influencing success after 10 min. Results: In total, 60 anaesthesiologists (LTS group <i>n</i> = 30; Cuff group <i>n</i> = 30) with a median experience of 7 years (IQR 4-11) were observed. Within 10 min, a malpositioned laryngeal tube was successfully exchanged by 27/30 (90%) participants, compared to the exchange of a tracheal tube with a relevant cuff leakage by 29/30 (97%; <i>p</i> > 0.05). An airway exchange in an obstructed tube scenario occurred in 22/59 (37%). Loss of airway maintenance showed an obvious association with failure in the common scenario (<i>p</i> = 0.02). Conclusion: The results of this simulation-based study reflect that the exchange of an existing but insufficient airway device in clinical practice is a high-risk procedure. Especially in a fixed prone position, the deliberate evaluation of the existing airway patency and well-conceived airway management in the case of the accidental loss of the airway or obstructed airway access are crucial.https://www.mdpi.com/2077-0383/13/1/16airway managementexisting airway devicetracheal intubationsimulationscenario traininganaesthesiology |
| spellingShingle | Marc Kriege Tim Demare Robert Ruemmler Irene Schmidtmann Janosh Wojciechowski Anneke Busch Thomas Ott Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study Journal of Clinical Medicine airway management existing airway device tracheal intubation simulation scenario training anaesthesiology |
| title | Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study |
| title_full | Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study |
| title_fullStr | Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study |
| title_full_unstemmed | Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study |
| title_short | Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study |
| title_sort | exchange of a tracheal tube and supraglottic airway device evaluation of different techniques in three simulated airway scenarios tube study a prospective randomised controlled study |
| topic | airway management existing airway device tracheal intubation simulation scenario training anaesthesiology |
| url | https://www.mdpi.com/2077-0383/13/1/16 |
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