End-expiratory carbon dioxide concentrations can be used to assist endotracheal intubation. The novel multimodal endotracheal intubation guidance device combined visualization with an end-expiratory carbon dioxide concentration vectorization algorithm to achieve more accurate placement in difficult airways. The feasibility of a novel multimodal guidance device for the endotracheal intubation of difficult airways was verified in spontaneously breathing Bama miniature pigs. The glottic exposure time, insertion time, and total intubation time were not significantly different between the fiberoptic bronchoscope group and the multimodal guidance device group in regard to the endotracheal intubation of difficult airways. There were also no significant differences in intubation attempts, first success rate, and total success rate. Animals in both groups experienced hypoxemia, hypotension,and esophageal intubation during endotracheal intubation, but there were also no significant differences in the incidence of adverse events between the two devices. The effect on changes in hemodynamics, heart rate, and oxygen saturation during intubation showed no significant difference between the two devices. The results of the present study demonstrated the feasibility and effectiveness of the initial prototype of a multimodal guidance device for the endotracheal intubation of difficult airways in pigs, which is expected to further assist in adequately positioning the airway during difficult endotracheal intubations with spontaneous breathing.
XIA Ming (夏明), XU Tianyi (徐天意), CAO Shuang (曹爽),ZHOU Ren (周韧), JIANG Hong* (姜虹)
. Evaluation of a Novel Multimodal Guidance Device for Difficult Airway Endotracheal Intubation in Spontaneously Breathing Pigs[J]. Journal of Shanghai Jiaotong University(Science), 2022
, 27(2)
: 256
-263
.
DOI: 10.1007/s12204-021-2330-4
[1] COOK T M, SCOTT S, MIHAI R. Litigation related to airway and respiratory complications of anaesthesia:An analysis of claims against the NHS in England 1995-2007 [J]. Anaesthesia, 2010, 65(6): 556-563.
[2] WHITLOCK E L, FEINER J R, CHEN L L. Perioperative mortality, 2010 to 2014: A retrospective cohort study using the national anesthesia clinical outcomes registry [J]. Anesthesiology, 2015, 123(6): 1312-1321.
[3] APFELBAUM J L, HAGBERG C A, CAPLAN R A,et al. Practice guidelines for management of the difficult airway: An updated report by the American society of anesthesiologists task force on management of the difficult airway [J]. Anesthesiology, 2013, 118(2):251-270.
[4] MURPHY T, HOWES B. Current practice for awake fibreoptic intubation - some unanswered questions [J].Anaesthesia, 2017, 72(6): 678-681.
[5] MOORE A, SCHRICKER T. Awake videolaryngoscopy versus fiberoptic bronchoscopy [J]. Current Opinion in Anaesthesiology, 2019, 32(6): 764-768.
[6] LINKO K, PALOHEIMO M. Capnography facilitates blind nasotracheal intubation [J]. Acta Anaesthesiologica Belgica, 1983, 34(2): 117-122.
[7] LEE L Y, LEE D, RYU H, et al. Capnography-guided endotracheal intubation as an alternative to existing intubation methods in rabbits [J]. Journal of the American Association for Laboratory Animal Science, 2019,58(2): 240-245.
[8] JANISZEWSKI A, PASWSKI R, SKRZYPCZAK P,et al. The use of a plastic guide improves the safety and reduces the duration of endotracheal intubation in the pig [J]. The Journal of Veterinary Medical Science,2014, 76(10): 1317-1320.
[9] DUKE-NOVAKOVSKI T, AMBROS B, AUCKLAND C D, et al. The effects of succinylcholine or low-dose rocuronium to aid endotracheal intubation of adult sows [J]. Canadian Journal of Veterinary Research,2012, 76(1): 57-61.
[10] HUH H, LIM H H, KIM J Y, et al. A novel and simple method for tracheal intubation in a swine model:Preparing for the era of xenotransplantation [J]. Experimental and Clinical Transplantation, 2017, 15(4):453-457.
[11] RUEMMLER R, ZIEBART A, OTT T, et al. Flexible fibreoptic intubation in swine - improvement for resident training and animal safety alike [J]. BMC Anesthesiology,2020, 20(1): 206.
[12] BIRO P, HOFMANN P, GAGE D, et al. Automated tracheal intubation in an airway manikin using a robotic endoscope: A proof of concept study [J].Anaesthesia, 2020, 75(7): 881-886.
[13] HSU C, LIN H, WU Y, et al. Assessment of a new method to distinguish esophageal from tracheal intubation by measuring the endotracheal cuff pressure in a porcine model [J]. Annals of Emergency Medicine,2004, 44(4): S119.
[14] LOCKEY D J, AVERY P, HARRIS T, et al. A prospective study of physician pre-hospital anaesthesia in trauma patients: Oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment [J]. BMC Anesthesiology, 2013, 13(1): 21.
[15] HUNT K A, YAMADA Y, MURTHY V, et al. Detection of exhaled carbon dioxide following intubation during resuscitation at delivery [J]. Archives of Disease in Childhood Fetal and Neonatal Edition, 2019, 104(2):F187-F191.
[16] BLACKBURN M B, NAWN C D, RYAN K L. Testing of novel spectral device sensor in swine model of airway obstruction [J]. Physiological Reports, 2019, 7(19):e14246.
[17] KUGELMAN A, ZEIGER-AGINSKY D, BADER D,et al. A novel method of distal end-tidal CO2 capnography in intubated infants: Comparison with arterial CO2 and with proximal mainstream end-tidal CO2 [J].Pediatrics, 2008, 122(6): e1219-e1224.
[18] BALOGH A L, PETAK F, FODOR G H, et al. Capnogram slope and ventilation dead space parameters:Comparison of mainstream and sidestream techniques[J]. British Journal of Anaesthesia, 2016, 117(1): 109-117.
