A comparison of difficult intubation documentation practices with existing guidelines in the advent of video laryngoscopy - 22/07/20
, Jun Liu, Ph.D b, Richard D. Urman, MD a , Kara G. Fields, M.S a , Dongdong Yao, M.D., Ph.D a, c, ⁎ Abstract |
Study objective |
To assess whether anesthesia providers' interpretations of a difficult intubation are consistent with current guidelines and explore possible explanations for any observed discrepancy including video laryngoscopy usage.
Design |
A retrospective data analysis of tracheal intubation records from the electronic health record of a large healthcare system in the United States from January to June 2018.
Setting |
General anesthesia encounters that involved a tracheal intubation in the operating rooms and non-operating room areas, including procedural areas, medical/surgical floors, and intensive care units.
Patients |
Records for 30,072 adult patients (33,142 cases) were identified for analysis. Patient age ranged from 18 to 100 and ASA physical status from I to V.
Interventions |
None.
Measurements |
The magnitude and direction of disagreement regarding intubation difficulty was estimated by examining anesthesiologist documentation vs. the American Society of Anesthesiologists guideline definitions. Any explanations for disagreement provided by clinicians were also analyzed. Furthermore, the association between video laryngoscopy and odds of disagreement was assessed.
Main results |
While documentation of intubation difficulty in over 95% of records was consistent with current definitions, disagreement occurred in 1.6% of cases using the number of attempts definition (N = 31,964) and in 4.6% of cases using the Cormack-Lehane grade definition (N = 25,407). Some of the most frequently identified explanations clinicians gave in these cases of disagreement included the use of video laryngoscopy (used to explain documented difficult and easy intubations), clinician experience level, and the use of airway assist devices. Video laryngoscopy use was associated with greater odds of disagreement between anesthesiologist documentation and guideline definitions.
Conclusions |
A review of electronic anesthesia records suggests that clinicians inconsistently interpret and document difficult intubations in light of current guideline definitions and that video laryngoscopy usage appears to be associated, albeit not necessarily independently, with a greater discrepancy between anesthesiologist documentation and guideline definitions.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Agreement between clinician documented and guideline defined intubation difficulty occurred in > 95% of records |
• | Frequent discrepancy occurred in encounters that met guideline criteria for difficult intubation |
• | Video laryngoscopy use was commonly identified by clinicians to explain discrepant cases |
• | Refining the difficult intubation definition would benefit patient care and inter-clinician communication |
Keywords : Airway, Difficult intubation, Video laryngoscopy, Guidelines, Management, Intubation
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Vol 65
Article 109807- octobre 2020 Retour au numéro
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