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. 2023 Dec 19;13(1):16.
doi: 10.3390/jcm13010016.

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

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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

Marc Kriege et al. J Clin Med. .

Abstract

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 (SpO2 < 80%) arose. Secondary endpoints were the evaluation of factors influencing success after 10 min.

Results: In total, 60 anaesthesiologists (LTS group n = 30; Cuff group n = 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%; p > 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 (p = 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.

Keywords: airway management; anaesthesiology; existing airway device; laryngeal masks; laryngoscopy; scenario training; simulation; tracheal intubation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Consort diagram.
Figure 2
Figure 2
(a) LTS: River plot visualising the path to success or failure in the three scenarios during the particular attempts. (b) CUFF: River plot visualising the path to success or failure in the three scenarios during the particular attempts. (c) PRONE: River plot visualising the path to success or failure in the three scenarios during the particular attempts. Legend (Figure 2a–c): The river plots illustrate the paths of the applied instruments to success or failure of a scenario. The river plots generally start with a phase of planning, where no action was observed (Start: None (planning)). Then, the attempts were launched consecutively, coded by the number of the attempt (1, 2, 3, 4), and the following instruments were applied: LM: laryngeal mask, Stylet: any kind of AEC, FO: flexible endoscopy, VL: video laryngoscopy, DL: direct laryngoscopy. The thickness of the “rivers” is proportional to the number of participants using the particular instrument.

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