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Randomized Controlled Trial
. 2025 Feb 1;140(2):280-289.
doi: 10.1213/ANE.0000000000007273. Epub 2024 Dec 20.

Effectiveness of Ventilation via an Endotracheal Tube in Pharynx Versus a Facemask in Patients With Potentially Difficult Airway: A Randomized, Crossover, and Blind Trial

Travis Markham  1 , Abraham S AlFarra  2 , Mubeen Tejani  3 , Daniel J Tate  4 , Jose E Barrera  5 , Sreelekha Paladugu  6 , Sepideh Saroukhani  7   8 , Yandong Jiang  1
Affiliations
Randomized Controlled Trial

Effectiveness of Ventilation via an Endotracheal Tube in Pharynx Versus a Facemask in Patients With Potentially Difficult Airway: A Randomized, Crossover, and Blind Trial

Travis Markham et al. Anesth Analg. .

Abstract

Background: The difficult airway is frequently encountered across many scenarios. The extreme form is a "cannot intubate and cannot oxygenate" scenario, which lacks a reliable rescue technique. Previous case reports or studies with small sample sizes indicate the feasibility and efficiency of an endotracheal tube in the pharynx (TTIP) to ventilate patients. We hypothesize that ventilation via TTIP is an effective rescue technique for failed mask ventilation.

Method: One hundred forty-seven patients with potentially difficult airways were randomly assigned to the sequence (Tube first) of tube first ventilation via TTIP for 1 minute after induction, followed by via mask ventilation for 1 minute or in reverse sequence (Mask first). The ventilation was done with pressure control mode, a peak inspiratory airway pressure of 20 cmH 2 O, an inspiratory to expiratory time ratio of 1:2, and a respiratory rate of 10 breaths/min.

Results: A total of 136 patients underwent final analysis. The overall success rate (primary outcome) of ventilation via TTIP and mask, defined as the presence of expired carbon dioxide, was 93.4% (127/136) and 84.6% (115/136), respectively ( P = .02). The success rate, 85.7% (6/7), of mask ventilation rescuing a failed TTIP ventilation and 100% (13/13) of TTIP rescuing a failed mask ventilation were comparable ( P = .35).

Conclusions: The success rates of TTIP and mask ventilation are comparable. Ventilation via TTIP could be an alternative rescue technique for managing a difficult airway.

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Conflict of interest statement

Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article.

References

    1. Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology. 2019;131:818–829.
    1. Cook TM, Woodall N, Harper J, Benger J; 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 2: intensive care and emergency departments. Br J Anaesth. 2011;106:632–642.
    1. Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136:31–81.
    1. Tachibana N, Niiyama Y, Yamakage M. Incidence of cannot intubate-cannot ventilate (CICV): results of a 3-year retrospective multicenter clinical study in a network of university hospitals. J Anesth. 2015;29:326–330.
    1. Frerk C, Mitchell VS, McNarry AF, et al.; Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827–848.

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