The problem of “difficult airways” — multicenter studies of Federation of anaesthesiologists and reanimatologists to analyze current clinical practice and review the training system in the Russian Federation. Review

A.A. Andreenko1, E.L. Dolbneva2, V.I. Stamov3

1 FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, St. Petersburg, Russia

2 FGBNU “RNCH named by acad. B.V. Petrovsky”, Moscow, Russia

3 UKB № 2 FGAOU VO “Moscow State Medical University named after I.M. Sechenov” Ministry of Health of Russia, Moscow, Russia

For correspondence: Aleksander A. Andreenko — Cand. Med. Sciences, Assistant Professor, Deputy Head of the Department of Anesthesiology and Resuscitation FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, St. Petersburg; e-mail: aaa010803@gmail.com

For citation: Andreenko AA, Dolbneva EL, Stamov VI. The problem of “difficult airways” — multicenter studies of Federation of anaesthesiologists and reanimatologists  to analyze current clinical practice and review the training system in the Russian Federation. Review. Annals of Critical Care. 2019;3:34–41.

DOI: 10.21320/1818-474X-2019-3-34-41


Abstract

“Difficult airways” situations continue to be one of the main causes of anesthetic mortality and morbidity. Current requirements of patient safety during anesthesia determine the need for the necessary equipment and compliance with existing clinical guidelines. The situation with the equipment of hospitals in the Russian Federation with different airway devices and medical equipment, as well as the approaches used by anesthesiologists are regularly reviewed by the FAR Committee of Difficult Airways by distributing a questionnaire. During the last 10 years there has been a positive trend in the level of hospital equipment with supraglottic airways, there has been an increase in the awareness of specialists about the existing clinical guidelines. An updated version of the survey was developed to examine the current situation in the Russian Federation, to analyze the effectiveness of the approaches used to solve the problem of “difficult airways” and to evaluate the role of the existing recommendations of the FAR.

The role of the human factor is decisive in the development of a significant part of critical situations during anesthesia. A modern training program for clinical residents in anesthesiology should include training in upper airways assessment, performing basic maneuvers of airways management, working out techniques for using various devices, as well as using existing algorithms of actions during “difficult airways” situations. The ability to apply theoretical knowledge and act requires training in a high-fidelity simulation and subsequent analysis of residentʹs performance. The newly developed survey is devoted to the analysis of the situation with airways management training in the clinical residency. Based on the results of the survey, it is planned to develop a draft national airways management training program for anesthesia residents.

Keywords: airways management, difficult airways, human factor, critical situations, airways management training, national survey of airways management.

Received: 22.07.2019

Accepted: 03.09.2019


References

  1. Mora J.C. , Kaye A.D., et al. Trends in Anesthesia-Related Liability and Lessons Learned. Advances in Anesthesia. 2018; 36: 231–249.
  2. Metzner J., Posner K.L., Lam M.S., Domino K.B. Closed claims’ analysis. Best. Pract. Res. Clin. Anaesthesiol. 2011; 25(2): 263–276. DOI: 10.1016/j.bpa.2011.02.007
  3. Peterson G.N., Domino K.B., Caplan R.A., et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005; 103(1): 33–39.
  4. Schroeder R.A., Pollard R., Dhakal I., et al. Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional Community Anesthetic Practice. Anesthesiology. 2018; 128(3): 502–510. DOI: 10.1097/ALN.0000000000001974
  5. Cook T.M., Woodall N., Frerk C. Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br. J. Anaesth. 2011; 106(5): 617–631. DOI: 10.1093/bja/aer058
  6. Долбнева Е., Стамов В., Андреенко А., Бунятян А. Анализ проблемы «трудных дыхательных путей» в России: особенности и перспективы. Часть 1. Медицинский алфавит. 2016; 20(283): 9–13.[Dolbneva E.L., Stamov V.I., Andreenko A.A., Bunatyan A.A. Analysis of the problem of “difficult airways” in Russia: features and prospects. Part 1. Medicinsky Alphavit. 2016; 20(283): 9–13. (In Russ)]
  7. Приговор № 1-10/20151-382/2014 от 3 марта 2015 г. по делу № 1-10/2015 [электронный документ]. Доступно по: https://sudact.ru/regular/doc/IUmwqhuLkC5v/. Ссылка активна на 22.07.2019. [Prigovor № 1-10/20151-382/2014 ot 3 marta 2015 g. po delu № 1-10/2015 [Internet]. Available from: https://sudact.ru/regular/doc/IUmwqhuLkC5v/ (accessed 22.07.2019). (In Russ)]
  8. Приговор от 28 ноября 2013 г. по делу № 1-335/2013 [электронный документ]. Доступно по: http://www.gcourts.ru/case/17427727. Ссылка активна на 22.07.2019. [Prigovor ot 28 noyabrya 2013 g. po delu № 1-335/2013 [Internet]. Available from: http://www.gcourts.ru/case/17427727 (accessed 22.07.2019). (In Russ)]
  9. Гаврилова Е.Г. Дефекты анестезиолого-реанимационной помощи (по материалам комиссионных судебно-медицинских экспертиз). Анестезиология и реаниматология. 2014; 2: 70–75. [Gavrilova E.G. Defects of anesthesiology and resuscitation care (based on materials of forensic medical examinations). Anestesiologia I reanimatologia. 2014; 2: 70–75. (In Russ)]
  10. Долбнева Е., Стамов В., Андреенко А., Бунятян А. Анализ проблемы «трудных дыхательных путей» в России: особенности и перспективы. Часть 2. Медицинский алфавит. 2016; 33 (296): 34–39.[Dolbneva E.L., Stamov V.I., Andreenko A.A., Bunatyan A.A. Analysis of the problem of “difficult airways” in Russia: features and prospects. Part 2. Medicinsky Alphavit. 2016; 33(296): 34–39. (In Russ)].
  11. Андреенко А.А., Долбнева Е.Л., Стамов В.И. Обеспечение проходимости верхних дыхательных путей в стационаре. Клинические рекомендации Федерации анестезиологов-реаниматологов России (второй пересмотр, 2018 г.). Вестник интенсивной терапии им. А.И. Салтанова. 2019; 2: 7–31. DOI: 10.21320/1818-474X-2019-2-7-7-31 [Andreenko A.A., Dolbneva E.L., Stamov V.I. Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018). Alexander Saltanov Intensive Care Herald. 2019; 2: 7–31. (In Russ)]
  12. Rajesh M.C., Suvarna K., Indu S., et al. Current practice of difficult airway management: A survey. Indian J Anaesth. 2015; 59(12): 801–806. DOI: 10.4103/0019–5049.171571
  13. Gómez-Prieto M.G., Míguez-Crespo M.R., Jiménez-del-Valle J.R., et al. National survey on airway and difficult airway management in intensive care units. Med Intensiva. 2018; 42(9): 519–526. DOI: 10.1016/j.medin.2018.01.001
  14. Astin J., King E.C., Bradley T., et al. Survey of airway management strategies and experience of non-consultant doctors in intensive care units in the UK. Br J Anaesth. 2012; 109: 821–825.
  15. Cook T.M., Kelly F.E. A national survey of videolaryngoscopy in the United Kingdom. British Journal of Anaesthesia. 2017; 4 (118): 593–600. DOI: 10.1093/bja/aex052
  16. Bjurström M.F., Persson K., Sturesson L.W. Availability and Organization of Difficult Airway Equipment in Swedish Hospitals: A National Survey of Anaesthesiologists. Acta Anaesthesiol Scand. 2019; 8. DOI: 10.1111/aas.13448
  17. Wong D.T., Mehta A., Tam A.D., et al. A survey of Canadian anesthesiologistsʼ preferences in difficult intubation and “cannot intubate, cannot ventilate” situations. Can J Anaesth. 2014; 61(8): 717–726. DOI: 10.1007/s12630-014-0183-0
  18. Gleeson S., Groom P., Mercer S. Human factors in complex airway management. BJA Education. 2016; 16: 191–197. DOI: doi.org/10.1093/bjaed/mkv045
  19. Jones C.P.L., Fawker-Corbett J., Groom P., et al. Human factors in preventing complications in anaesthesia: a systematic review. Anaesthesia. 2018; 73(Suppl. 1): 12–24. DOI: 10.1111/anae.14136
  20. Frerk C., Mitchell V.S., McNarry A.F., et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia 2015; 115: 827–848.
  21. Lindkær Jensen N.H., Cook T.M., Kelly F.E. A national survey of practical airway training in UK anaesthetic departments. Time for a national policy? Anaesthesia. 2016; 71: 1273–1279. DOI: 10.1111/anae.13567
  22. Dunn S., Connelly N.R., Robbins L. Resident training in advanced airway management. J Clin Anesth. 2004; 16(6): 472–476.
  23. Spaliaras J., Streiff A., Mann G., Straker T. Teaching and training in airway management: Time to evaluate the current model? Airway. 2019; 2: 28–35.
  24. Ono Y., Tanigawa K., Shinohara K., et al. Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional studyю Int J Emerg Med. 2017; 10: 28. DOI: 10.1186/s12245-017-0155-6
  25. Joffe A.M., Liew E.C., Olivar H., et al. A National Survey of Airway Management Training in United States Internal Medicine-Based Critical Care Fellowship Programs. Respiratory Care July. 2012; 57 (7): 1084–1088. DOI: https://doi.org/10.4187/respcare.01540
  26. Pott L.M., Randel G.I., Straker T., et al. A survey of airway training among U.S. And Canadian anesthesiology residency programs. J Clin Anesth 2011; 23: 15–26.
  27. Hagberg C.A. Combined fellowship training in head and neck anesthesia and advanced airway management. J Head Neck Anesth. 2019; 3: e9.
  28. Society for Head and Neck Anesthesia Consensus Statement. Available from: http://www.shanahq.com/main/content/consensus.statement. [Last accessed on 2019 Mar 10]
  29. Straker T. Airway management: Isn’t that what anesthesiologists do? J Head Neck Anesth. 2019; 3: e11.
  30. Sun Y., Pan C., Li T., Gan T.J. Airway management education: Simulation based training versus non simulation based training. A systematic review and meta-analyses. BMC Anesthesiol. 2017; 17: 17.
  31. Зайцев А., Дубровин К., Светлов В. Роль методов визуализации для обеспечения безопасности пациента в анестезиологической практике (обзор). Общая реаниматология. 2018; 14(6): 80–94.[Zaitsev A.Y., Dubrovin K.V., Svetlov V.A. Сontribution of Imaging Techniques for Patientʼs Safety in Anesthesiology Practice (Review). General Reanimatology. 2018; 14(6): 80–94. (In Russ.)] DOI: 10.15360/1813-9779-2018-6-80-94