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Altinsoy S, Sayin MM, Özkan D, Çatalca S, Ergil J. Is HFJV a better alternative ventilation technique for percutaneous dilatational tracheostomy? A randomised trial. Minerva Anestesiol 2022; 88:588-593. [PMID: 35191643 DOI: 10.23736/s0375-9393.22.16196-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND High-Frequency Jet Ventilation (HFJV) has been used for the treatment of tracheal lesions, airway surgery, and treatment of secondary lesions after tracheostomy for many years however, reports on the use of HFJV during PDT are limited. This study compares the use of traditional method, ventilation with LMA, and HFJV through ETT with respect to the duration of PDT procedure and complications. METHODS Seventy-five patients were randomized into one of the three groups with computergenerated random numbers: Group ETT (n_25), group LMA (n=25), and group HFJV (n=25). Demographic data, duration of PDT, complications such as ETT cuff puncture and tube transaction, accidental extubation, difficult cannula insertion, bleeding, desaturation during the procedure, arterial blood gases immediately before and after the procedure have been recorded. RESULTS Mean time for successful PDT in group ETT was 5.9±1.35 minutes, in group LMA 4.96±0.78 minutes, and 3.88±0.78 minutes in group HFJV. PDT duration was shorter in the LMA group than in the ETT group (p<0.05). In the HFJV group, the PDT duration was shorter than the LMA group (p<0.05) and the ETT group (p<0.001). In terms of the total number of complications, significantly fewer complications were observed in the HFJV group compared with group ETT and group LMA. CONCLUSIONS HFJV may be a more effective alternative method for airway management during PDT, facilitating and reducing the duration of the intervention.
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Affiliation(s)
- Savaş Altinsoy
- Department of Anesthesiology and Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital, University of Healt Sciences, Ankara, Turkey -
| | - MMurat Sayin
- Department of Anesthesiology and Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital, University of Healt Sciences, Ankara, Turkey
| | - Derya Özkan
- Department of Anesthesiology and Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital, University of Healt Sciences, Ankara, Turkey
| | - Sibel Çatalca
- Department of Anesthesiology and Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital, University of Healt Sciences, Ankara, Turkey
| | - Jülide Ergil
- Department of Anesthesiology and Reanimation, Diskapi Yildirim Beyazit Training and Research Hospital, University of Healt Sciences, Ankara, Turkey
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Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics. J Bronchology Interv Pulmonol 2020; 26:179-183. [PMID: 30741843 DOI: 10.1097/lbr.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways, largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here, we seek to describe the safety and efficiency of that approach. METHODS This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length, sedative totals, and safety outcomes were recorded. RESULTS In total, 125 patients underwent PT during the study period, 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5±21.4 min vs. ETT: 50.4±16.8; P=0.41), total complications (LMA: 29.3% vs. 16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0±3.6 mg vs. ETT: 11.5±5.9 mg; P<0.01). CONCLUSION Replacing the ETT with an LMA before PT is equally safe, does not increase total procedural duration, and all but eliminates the need for paralytic agents.
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Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy. ACTA MEDICA BULGARICA 2019. [DOI: 10.2478/amb-2019-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway.
Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy.
Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia.
Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation : recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF) et de la Société française d’anesthésie et de réanimation (SFAR), en collaboration avec la Société française de médecine d’urgence (SFMU) et la Société française d’otorhinolaryngologie (SFORL). MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2018-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Strametz R, Bergold MN, Weberschock T. Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults. Cochrane Database Syst Rev 2018; 11:CD009901. [PMID: 30536850 PMCID: PMC6956469 DOI: 10.1002/14651858.cd009901.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adults, on intensive care units (ICUs), who require long-term ventilation. PDT is associated with relevant life-threatening complications: Cuff rupture or accidental extubation may lead to hypoxia, aspiration or loss of airway. Puncture of the oesophagus, or creating a false passage during dilatation or replacement of the tracheostomy tube, can lead to pneumothorax or emphysema. Wound infections may occur which can cause mediastinits, especially after creation of false passage or in early tracheotomized post-sternotomy patients after cardiac surgery. During the procedure, the patient's airway can be secured with an endotracheal tube (ETT) or a laryngeal mask airway (LMA). This is an updated version of the review first published in 2014. OBJECTIVES To assess the safety and effectiveness of LMA versus ETT in critically ill adults undergoing PDT on the ICU. SEARCH METHODS We searched the following databases to 9 January 2018: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase. We searched for reports of ongoing trials in the metaRegister of Controlled Trials (mRCT). We handsearched for relevant studies in conference proceedings of five relevant annual congresses. We contacted study authors and experts concerning unpublished data and ongoing trials. We searched for further relevant studies in the reference lists of all included trials and of relevant systematic reviews. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared use of laryngeal mask airways versus endotracheal tubes in critically ill adults undergoing elective PDT in the ICU, without injuries to or diseases of the face or neck. We imposed no restrictions with regard to language, timing or technique of PDT performed. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and methodological quality of each study and carried out data extraction. Our primary outcomes were all-cause mortality, procedure-related mortality and tally of participants with one or more serious adverse events. Where possible, we combined homogeneous studies for meta-analysis. We used Cochrane's 'Risk of bias' tool and used GRADE to assess the quality of evidence for key outcomes. MAIN RESULTS We included nine RCTs in this review involving 517 participants.Studies had a high or unclear risk of bias. The main reason for this was low methodological quality or missing data, even after study authors were contacted. Study size was generally small, with a minimum of 40, and a maximum of 73 participants.In one study (40 participants), three deaths in the LMA group and two deaths in the ETT group were reported, although none of the deaths were related to the procedure (very low-quality evidence).Five studies (281 participants) reported on procedure-related deaths, stating that no procedure-related death occurred at all (very low-quality evidence).It is uncertain whether there is a difference in the number of people experiencing one or more serious adverse event(s) between LMA and ETT (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.41 to 1.80; 467 participants, 8 studies, very low-quality evidence).The duration of the procedure may be shorter in the LMA group (mean difference (MD) -1.46 minutes, 95% CI -1.92 to -1.01 minutes; 6 studies, 324 participants, low-quality evidence).However failure of procedure, as allocated by randomization, requiring conversion to any other procedure, may be higher in the LMA group (RR 2.82, 95% CI 1.22 to 6.52; 8 studies, 439 participants, low-quality evidence).We did not find any clear evidence of a difference between ETT and LMA groups for all other outcomes. Only one study provided follow-up data for late complications related to the intervention, showing no clear evidence of benefit for any treatment group. AUTHORS' CONCLUSIONS Evidence on the safety of LMA for PDT is too limited to allow conclusions to be drawn on either its efficacy or safety compared with ETT. Although the LMA procedure may shorten the period during which the airway is insecure, it may also lead to higher conversion rates. Also, late complications have not been investigated sufficiently. These results are primarily based on single-centre trials with small sample sizes, and therefore the level of evidence remains low. Studies with low risk of bias focusing on late complications and relevant patient-related outcomes are necessary for definitive conclusions on safety issues related to this procedure. The dependency of the successful placement of a LMA on the type of LMA used should also be further assessed.There are two studies awaiting classification that may alter the conclusions once assessed.
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Affiliation(s)
- Reinhard Strametz
- RheinMain University of Applied ScienceWiesbaden Business SchoolBleichstr. 44WiesbadenGermany65183
| | - Martin N Bergold
- Evangelisches Krankenhaus Oldenburg ‐ European Medical SchoolDepartment of Anesthesiology, Intensive Care Medicine and Pain TherapySteinweg 13‐17OldenburgGermanyD‐26122
| | - Tobias Weberschock
- Johann Wolfgang Goethe‐University HospitalDepartment of Dermatology, Venereology and AllergologyTheodor‐Stern‐Kai 7Frankfurt am MainGermany60590
- Goethe UniversityEvidence‐Based Medicine Frankfurt, Institute for General PracticeTheodor Stern Kai 7FrankfurtGermany60590
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L’Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Trachéotomie en réanimation. ANESTHÉSIE & RÉANIMATION 2018. [DOI: 10.1016/j.anrea.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine. Anaesth Crit Care Pain Med 2018; 37:281-294. [PMID: 29559211 DOI: 10.1016/j.accpm.2018.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1±) and 6 a low level of proof (Grade 2±). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean-Louis Trouillet
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Olivier Collange
- Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, pôle d'anesthésie-réanimation chirurgicale, SAMU, SMUR, NHC, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France.
| | - Fouad Belafia
- Inserm, U1046, intensive care unit and department of anesthesiology, research unit, university of Montpellier, Saint-Éloi hospital, Montpellier school of medicine, 34000 Montpellier, France
| | - François Blot
- Medical-surgical intensive care unit, Gustave-Roussy Cancer Campus, 94800 Villejuif, France
| | - Gilles Capellier
- EA3920, université de Franche-Comté, CHRU de Besançon, 25000 Besançon, France; Australian and New Zealand intensive care research centre, department of epidemiology and preventive medicine, Monash University Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and department of emergency medicine, Hospices Civils de Lyon, Edouard-Herriot hospital, 69003 Lyon, France; Lyon Sud, school of medicine, university Lyon 1, 69600 Oullins, France
| | - Jean-Michel Constantin
- Department of preoperative medicine university hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France; EA-7281, R2D2, Auvergne University, 63000 Clermont-Ferrand, France
| | - Alexandre Demoule
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Jean-Luc Diehl
- Medical ICU, Georges-Pompidou European Hospital, AP-HP, 75016 Paris, France; Inserm UMR-S1140 Paris Descartes University and Sorbonne Paris Cité, 75006 Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and critical care department, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens, France; Inserm, U1088, Jules-Verne University of Picardy, 80054 Amiens, France
| | - Franck Jegoux
- Service ORL et chirurgie cervico-maxillofaciale, CHU de Pontchaillou, rue H.-Le-Guilloux, 35033 Rennes cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM Inserm, UMR 1101, université de Bretagne Occidentale, rue Camille-Desmoulins, 29200 Brest cedex, France; Médecine intensive et réanimation CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest cedex, France
| | - Charles-Edouard Luyt
- Service de réanimation, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France; Inserm, UMRS-1166, UPMC, université Paris 06, ICAN, institute of cardiometabolism and nutrition sorbonne universités, 75013 Paris, France
| | - Yazine Mahjoub
- Department of anesthesia and intensive care, Amiens-Picardie, university Hospital, 80054 Amiens, France
| | - Julien Mayaux
- Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique Sorbonne Université, 75013 Paris France; AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie et réanimation médicale du département R3S, Sorbonne Université Paris, 75013 Paris, France
| | - Hervé Quintard
- Réanimation médico-chirurgicale, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France; CNRS, UMR 7275, IPMC, 06560 Sophia Antipolis Valbonne, France
| | - François Ravat
- Centre des brûlés, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Sébastien Vergez
- ORL chirurgie cervicofaciale, CHU de Toulouse, Rangueil-Larrey, 24, chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | - Julien Amour
- Département d'anesthésie et de réanimation chirurgicale, institut de cardiologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Max Guillot
- EA 3072, FMTS université de Strasbourg, 67000 Strasbourg, France; Hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, réanimation médicale, avenue Molière, 67200 Strasbourg, France.
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8
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Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care 2018; 8:37. [PMID: 29546588 PMCID: PMC5854567 DOI: 10.1186/s13613-018-0381-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/08/2018] [Indexed: 12/29/2022] Open
Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
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Affiliation(s)
- Jean Louis Trouillet
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Collange
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle d'Anesthésie-Réanimation Chirurgicale, SAMU, SMUR, NHC, 1 Place de l'Hôpital, 67000, Strasbourg, France.,EA 3072, FMTS, Université de Strasbourg, Strasbourg, France
| | - Fouad Belafia
- Intensive Care Unit and Department of Anesthesiology, Research Unit INSERM U1046, University of Montpellier Saint Eloi Hospital and Montpellier School of Medicine, Montpellier, France
| | - François Blot
- Medical-Surgical Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Gilles Capellier
- CHRU Besançon 25000, EA3920 Université de Franche-Comté, Besançon, France.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Eric Cesareo
- SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Lyon Sud School of Medicine, University Lyon 1, Oullins, France
| | - Jean-Michel Constantin
- Department of Preoperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France
| | - Alexandre Demoule
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Jean-Luc Diehl
- Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.,INSERM UMR-S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.,INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France
| | - Franck Jegoux
- Service ORL et Chirurgie Cervico-maxillo-Faciale, CHU PONTCHAILLOU, Rue H. Le Guilloux, 35033, Rennes Cedex 9, France
| | - Erwan L'Her
- CeSim/LaTIM INSERM UMR 1101, Université de Bretagne Occidentale, Rue Camille Desmoulins, 29200, Brest Cedex, France.,Médecine Intensive et Réanimation, CHRU de Brest, Boulevard Tanguy Prigent, 29200, Brest Cedex, France
| | - Charles-Edouard Luyt
- Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France
| | - Yazine Mahjoub
- Department of Anesthesia and Intensive Care, Amiens-Picardie University Hospital, Amiens, France
| | - Julien Mayaux
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France
| | - Hervé Quintard
- Réanimation médico chirurgicale Hôpital Pasteur 2 CHU de Nice, 30 voie romaine, 06000, Nice, France.,CNRS UMR 7275, IPMC Sophia Antipolis, Valbonne, France
| | - François Ravat
- Centre des brûlés, Centre Hospitalier St Joseph et St Luc, 20 quai Claude Bernard, 69007, Lyon, France
| | - Sebastien Vergez
- ORL Chirurgie Cervicofaciale, CHU Toulouse Rangueil-Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France
| | - Julien Amour
- Département d'Anesthésie et de Réanimation Chirurgicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Max Guillot
- EA 3072, FMTS, Université de Strasbourg, Strasbourg, France. .,Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Réanimation Médicale, Avenue Molière, 67200, Strasbourg, France.
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9
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Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2017; 120:323-352. [PMID: 29406182 DOI: 10.1016/j.bja.2017.10.021] [Citation(s) in RCA: 458] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/17/2022] Open
Abstract
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.
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Affiliation(s)
- A Higgs
- Anaesthesia and Intensive Care Medicine, Warrington and Halton Hospitals NHS Foundation Trust, Cheshire, UK(8).
| | - B A McGrath
- Anaesthesia and Intensive Care Medicine, University Hospital South Manchester, Manchester, UK(9)
| | - C Goddard
- Anaesthesia & Intensive Care Medicine, Southport and Ormskirk Hospitals NHS Trust, Southport, UK(8)
| | - J Rangasami
- Anaesthesia & Intensive Care Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK(8)
| | - G Suntharalingam
- Intensive Care Medicine and Anaesthesia, London North West Healthcare NHS Trust, London, UK(10)
| | - R Gale
- Anaesthesia & Intensive Care Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK(11)
| | - T M Cook
- Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK(12)
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10
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés Alban A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, Von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodriguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guides in tracheostomy use in critical patients. Med Intensiva 2017; 41:94-115. [PMID: 28188061 DOI: 10.1016/j.medin.2016.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- N Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Argentina
| | - M R Vial
- MD Anderson Cancer Center, The University of Texas, Texas, United States; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - J Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Quintero
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - A Cortés Alban
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - E Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - C Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - S Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - J M Añón
- Hospital Universitario la Paz -Carlos III. IdiPaz, Madrid, España
| | - G Hernández
- Complejo Hospitalario de Toledo, Toledo, España
| | - E Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - G Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - F Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Matos
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - E Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - P Antoniazzi
- Hospital Santa Casa, Ribeirao Preto, Sao Paulo, Brazil
| | - J M Teles
- Hospital de Urgências de Goiânia, Goiás, Brazil
| | - C Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - J Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | - L Martínez
- Hospital Policlínica Metropolitana, Caracas, Venezuela
| | - I Von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - J Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES", Guayaquil, Ecuador
| | - E Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, Texas, Estados Unidos
| | - M Arroyo
- Clínica Santa Sofía, Caracas, Venezuela
| | - C Rodriguez
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - J Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - S Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida, Estados Unidos
| | - J L Nates
- MD Anderson Cancer Center, The University of Texas, Texas, United States.
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11
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodríguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care 2016; 38:304-318. [PMID: 28103536 DOI: 10.1016/j.jcrc.2016.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. CONCLUSIONS Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- Néstor Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Macarena R Vial
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - José Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Agamenón Quintero
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Albán Cortés
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - Edgar Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Clara Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - Sebastián Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - José M Añón
- Hospital Universitario La Paz-Carlos III. IdiPaz, Madrid, Spain
| | | | - Erick Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - Guillermo Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - Fernando Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Alfredo Matos
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Enith Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Paulo Antoniazzi
- Hospital Santa Casa de Ribeirão Preto, Centro Universitário Barao de Maua, São Paulo, Brazil
| | | | - Carmelo Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - Jorge Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | | | - Ingrid von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - José Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES,", Guayaquil, Ecuador
| | - Edgar Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | | | - Camilo Rodríguez
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Javier Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Sebastián Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL
| | - Joseph L Nates
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
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12
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Dizdarevic A, Pagano P, Desai S. Anesthetic Implications for Tracheal Injury During Bronchoscopy-Guided Percutaneous Dilational Tracheostomy. ACTA ACUST UNITED AC 2016; 6:90-4. [PMID: 26859284 DOI: 10.1213/xaa.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchoscopic-guided percutaneous dilational tracheostomy has become one of the most common elective tracheostomy methods for patients requiring prolonged ventilatory support. The safety profile, patient selection, and risks as well as complication management, when compared with an open surgical technique, remain somewhat controversial with no clear recommendations. We present a case of a critically ill patient undergoing percutaneous dilation tracheostomy complicated by tracheal wall injury and airway loss. The airway was successfully conservatively managed as well as the tracheal injury. Anesthetic implications, safety, and management options as well as recommendations are reviewed.
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Affiliation(s)
- Anis Dizdarevic
- From the Department of Anesthesiology and Pain Management, Columbia University Medical Center, New York, New York
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13
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Consales G, Michelagnoli G, Zamidei L, Bettocchi D. Safety and efficacy of laryngeal mask airways during tracheostomy. Anaesthesia 2015; 70:236-7. [PMID: 25583200 DOI: 10.1111/anae.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Strametz R, Pachler C, Kramer JF, Byhahn C, Siebenhofer A, Weberschock T. Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adult patients. Cochrane Database Syst Rev 2014; 2014:CD009901. [PMID: 24979320 PMCID: PMC6464046 DOI: 10.1002/14651858.cd009901.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is one of the most common bedside surgical procedures performed in critically ill adult patients on intensive care units (ICUs) who require long-term ventilation. PDT is generally associated with relevant life-threatening complications (e.g. cuff rupture leading to possible hypoxia or aspiration, puncture of the oesophagus, accidental extubation, mediastinitis, pneumothorax, emphysema). The patient's airway can be secured with an endotracheal tube (ETT) or a laryngeal mask airway (LMA). OBJECTIVES To assess the safety and effectiveness of ETT versus LMA in critically ill adult patients undergoing PDT on the ICU.This review addresses the following research questions.1. Is an LMA more effective than an ETT in terms of procedure-related or all-cause mortality?2. Is an LMA safer than an ETT in terms of procedure-related life-threatening complications during a PDT procedure?3. Does use of an LMA influence the conditions for performing a tracheostomy (e.g. duration of procedure)? SEARCH METHODS We searched the Cochrane Database of Systematic Reviews (CDSR); the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 6 (part ofThe Cochrane Library); MEDLINE (from 1984 to 27 June 2013) and EMBASE (from 1984 to 27 June 2013). We searched for reports of ongoing trials in the metaRegister of Controlled Trials (mRCT). We handsearched for relevant studies in conference proceedings of the International Symposium on Intensive Care and Emergency Medicine (ISICEM), the Annual Congress of the European Society of Intensive Care Medicine (ESICM), the Annual Congress of the Society of Critical Care Medicine (SCCM), the American Thoracic Society (ATS) and the Annual Meeting of the American College of Chest Physicians (ACCP). We contacted study authors and experts concerning unpublished data and ongoing trials. We searched for further relevant studies in the reference lists of all included trials and of relevant systematic reviews identified in theCDSR. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared use of endotracheal tubes versus laryngeal mask airways in critically ill adult patients undergoing PDT on the ICU. We imposed no restrictions with regard to language, timing or technique of PDT performed. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility and methodological quality of each study and carried out data extraction. We resolved disagreements by discussion. Our primary outcomes were all-cause mortality, procedure-related mortality and tally of participants with one or more serious adverse events. When available, we reported on our secondary outcomes, which included duration of the procedure, failure of the procedure requiring conversion to any other procedure, time to extubation after tracheostomy, length of ICU stay after tracheostomy, length of hospital stay after tracheostomy and any other serious adverse events. When possible, we combined homogeneous studies for meta-analysis. We used the risk of bias tool of The Cochrane Collaboration to assess the internal validity of all included studies in six different domains. MAIN RESULTS We included in this review eight RCTs involving 467 participants. The included trials exclusively assessed critically ill participants (e.g. with head injury, neurological disease, multi-trauma, sepsis, acute respiratory failure (ARF) and/or chronic obstructive pulmonary disease (COPD)). Internal validity was considerably low in studies with a high or unclear risk of bias. The main reason for this was low methodological quality or missing data, even after study authors were contacted. Study size was generally small, with a minimum of 40 and a maximum of 73 participants. Only one study (40 participants) reported on overall mortality, showing no clear evidence of a difference between treatment groups (risk ratio (RR) 1.5, 95% confidence interval (CI) 0.28 to 8.04, Fisher test P value 1.0, low-quality evidence). Four studies (231 participants) reported that no procedure-related deaths occurred with any intervention. Seven studies reported the numbers of participants with adverse events, showing no clear evidence of benefit of either LMA or ETT during PDT (RR 0.73, 95% CI 0.35 to 1.52, P value 0.41, low-quality evidence). The tally of participants in included studies with adverse events ranged from 0% to 33% in the LMA group and from 0% to 50% in the ETT group. However, the duration of the procedure was significantly shorter in the LMA group (mean difference (MD) -1.46 minutes, 95% CI -1.92 to -1.01 minutes, 324 participants, P value ≤ 0.00001, low-quality evidence). No clear evidence of a difference between ETT and LMA groups was found for all other outcomes. Only one study provided follow-up data for late complications related to the intervention, showing no clear evidence of benefit for any treatment group. AUTHORS' CONCLUSIONS Evidence on the safety of LMA for PDT is too limited to allow conclusions to be drawn on its efficacy or safety compared with ETT. Although the LMA procedure is shorter because of optimal visual conditions, its effect on especially late complications has not been investigated sufficiently. Studies focusing on late complications and relevant patient-related outcomes are necessary for definitive conclusions on safety issues related to this procedure.
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Affiliation(s)
| | - Christoph Pachler
- Medical University of GrazDepartment of Anesthesiology and Intensive Care MedicineAuenbruggerplatz 29GrazAustria8036
| | - Johanna F Kramer
- Goethe UniversityEvidence‐Based Medicine Frankfurt, Institute of General PracticeTheodor‐Stern‐Kai 7FrankfurtGermany60590
| | | | - Andrea Siebenhofer
- Graz, Austria / Institute of General Practice, Goethe UniversityInstitute of General Practice and Evidence‐Based Health Services Research, Medical University of GrazFrankfurt am MainGermany
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