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Airway management problems are key drivers for anesthesia-related adverse events. Awake tracheal intubation using flexible bronchoscopes with preserved spontaneous breathing (ATI:FB) is a recommended technique to manage difficult tracheal intubation in anesthesia, intensive care and emergency medicine. However, a prospective developed classification for this type of airway management is lacking. Due to the absence of a specifically tailored, validated classification for awake intubation with flexible bronchoscopes, many airway operators and institutions use classification tools that were originally developed for direct laryngoscopy, such as the percentage of glottic opening (POGO) score or Cormack-Lehane classification, although their diagnostic performance for the classification of ATI:FB is unknown. This prospective model development and validation study aims to develop two multivariable prediction models: a diagnostic prediction model to classify difficult ATI:FB after ATI:FB has been performed and a second prognostic prediction model to predict the risk for difficult ATI:FB before ATI:FB is performed. An additional aim is to develop a machine learning algorithm to evaluate ATI:FB.
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| Measure | Description | Time Frame |
|---|---|---|
| Difficult awake flexible bronchoscopic intubation | Difficult airway alert issued by the airway operator following ATI:FB | 1 hour |
| Measure | Description | Time Frame |
|---|---|---|
| First attempt success | Number of participants with successful ATI:FB with only one attempt | 1 hour |
| Number of bronchoscopy attempts | Observed during airway management |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with anticipated difficult airways scheduled for surgery with general anaesthesia and tracheal intubation at a single study center
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Martin Petzoldt, MD, FEAMS | Contact | 04915222815932 | m.petzoldt@uke.de | |
| Vera Köhl, MD | Contact | v.koehl@uke.de |
| Name | Affiliation | Role |
|---|---|---|
| Martin Petzoldt, MD, FEAMS | University Medical Center Hamburg-Eppendorf: Universitatsklinikum Hamburg-Eppendorf | Principal Investigator |
| Vera Köhl, MD | University Medical Center Hamburg-Eppendorf: Universitatsklinikum Hamburg-Eppendorf |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Medical Center Hamburg-Eppendorf | Recruiting | Hamburg | Free and Hanseatic City of Hamburg | 20246 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39108225 | Background | Dohrmann T, Gutsche N, Kramer R, Zeidler EM, Roher K, Wunsch VA, Dankert A, Krause L, Zollner C, Sasu PB, Petzoldt M. Prospective development and validation of a universal classification for paediatric videolaryngoscopic tracheal intubation: the PeDiAC score. Anaesthesia. 2024 Nov;79(11):1201-1211. doi: 10.1111/anae.16394. Epub 2024 Aug 7. | |
| 37074950 |
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| ID | Term |
|---|---|
| D007818 | Laryngeal Diseases |
| ID | Term |
|---|---|
| D012140 | Respiratory Tract Diseases |
| D010038 | Otorhinolaryngologic Diseases |
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| 1 hour |
| Number of intubation attempts | Observed during airway management | 1 hour |
| Successful ATI:FB | Number of participants with successful ATI:FB | 1 hour |
| Successful bronchoscopy | Number of participants with successful bronchoscopy | 1 hour |
| Successful tube placement | Number of participants with successful tracheal tube placement | 1 hour |
| Coversion to another type of airway management | Observed during airway management | 1 hour |
| Conversion from transnasal to transoral bronchoscopy or vice versa | Observed during airway management | 1 hour |
| Percentage of glottic opening | Grading of the best view obtained during laryngoscopy (%) | 1 hour |
| Glottic view | Grading of the best view obtained using landmarks (6-stages) | 1 hour |
| Time to best glottic view | Recorded during airway management (seconds) | 1 hour |
| Time to intubation | Recorded during airway management (seconds) | 1 hour |
| Lowest oxygen saturation | Measured during airway management (%) | 1 hour |
| Endtidal CO2 | First value measured after intubation (mmHg) | 1 hour |
| Airway obstructions requiring external manipulation | Observed during airway management | 1 hour |
| Hypoxia | Observed during airway management | 1 hour |
| Cardiovascular event requiring intervention (hypotension/bradycardia) | Relevant hypotension or bradycardia observed during airway management | 1 hour |
| Cardiovascular event requiring intervention (hypertension, tachycardia) | Relevant hypertension or tachycardia observed during airway management | 1 hour |
| Additional manouvers and adjuncts used | Observed during airway management | 1 hour |
| Patient discomfort during ATI:FB | Observed during airway management | 1 hour |
| Airway-related complications | Observed during airway management | 1 hour |
| Anaesthesia alert card issued | Anaesthesia alert card issued by the airway operator | 1 hour |
| Recommendation for future airway management | Recommendation documented by the airway operator after airway management | 1 hour |
| Richmond agitation-sedation Scale | Observed during airway management (scale form -4 to 5 points; lower values indicate deeper sedation) | 1 hour |
| Subjective rating of difficulty of sedation, topicalisation, bronchoscopy and tube placement | Rating of the airway operator (visual analog scales [0-100]; lower values indicate better conditions) | 1 hour |
| Preparation time | Recorded during airway management | 1 hour |
| Barclay-Steuart A, Grosshennig HL, Sasu P, Wunsch VA, Stadlhofer R, Berger J, Stark M, Sehner S, Zollner C, Petzoldt M. Transnasal Videoendoscopy for Preoperative Airway Risk Stratification: Development and Validation of a Multivariable Risk Prediction Model. Anesth Analg. 2023 Jun 1;136(6):1164-1173. doi: 10.1213/ANE.0000000000006418. Epub 2023 Apr 19. |
| 36006056 | Background | Kohse EK, Siebert HK, Sasu PB, Loock K, Dohrmann T, Breitfeld P, Barclay-Steuart A, Stark M, Sehner S, Zollner C, Petzoldt M. A model to predict difficult airway alerts after videolaryngoscopy in adults with anticipated difficult airways - the VIDIAC score. Anaesthesia. 2022 Oct;77(10):1089-1096. doi: 10.1111/anae.15841. Epub 2022 Aug 25. |