【原】【周五】经典高分文献阅读·2019困难气道指南（2）

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今日共读 2019困难气道指南（二）

Why were these guidelines developed?

·Awake tracheal intubation (ATI) has a high success rate and a low-risk profile 成功率高，风险低 and has been cited as the gold standard in airway management for a predicted diffificultairway. 金标准

·However, ATI is reported to be used in as few as 0.2% of all tracheal intubations in the UK [1]. 但使用率只有0.2%

·There are barriers 障碍 preventing broad uptake and use of awaketechniques for securing the airway.

·We aimed to produce generalisable guidelines to improve patient safety by making ATI more accessible更容易接触 to all clinicians, trainers andinstitutions.

·Rather than inform expert practice, these guidelines aim to support the use of ATI by more clinicians, with a particular focus on those that do not regularly perform ATI 焦点在更多的临床医生，特别是那些不经常使用ATI的医生.

·There remains heterogeneity inclinical practice, underscoring the need for a more consistent approach using the available evidence, which these guidelines aim to deliver.

What other guidelines exist? （omit）

Introduction

·A strategy for diffificult airway management is necessary when facemask ventilation, supraglottic airway device (SAD)声门上装置 placement or ventilation, tracheal intubation or insertion of a front-of-neck airway (FONA)颈前气道 is predicted to be challenging.

·The incidence of diffificult facemask ventilationis 0.66–2.5% [14–17], diffificult SAD placement or ventilation0.5–4.7% [18–22], diffificult tracheal intubation 1.9–10% [14,16, 23–25] and combined diffificulty in both facemask and tracheal intubation 0.3–0.4% [16].

面罩通气困难的发生率为0.66-2.5%，SAD放置或通气困难发生率为0.5-4.7%，气管插管困难发生率为1.9–10%，面罩及插管均困难的发生率为0.3–0.4%

·As a rescue technique after failed tracheal intubation, one study reported that SADs have a success rate as low as 65% in diffificult airway management [26]. 一项研究报道，作为气管插管失败后的抢救技术，SADs在困难的气道管理中成功率低至65%。

·The reported incidence of requirement for emergency FONA 紧急颈前气道 and death due to airway managementare 0.002–0.07% (1:50,000–1:1400) [1, 27, 28] and 0.0006–0.04% (1:180,000–1:2800), respectively [1, 28].

·The risk and severity of adverse outcomes during diffificult airway management is highlighted by the plethora of guidelines and cognitive aids for airway rescue [29].

·Awake tracheal intubation involves placing a tracheal tube in an awake, spontaneously-breathing 自主呼吸patient, most commonly with flexible bronchoscopy纤维支气管镜 (ATI:FB) or video laryngoscopy可视喉镜 (ATI:VL, Table 1).

·好处：This allows the airway to be secured before induction of general anaesthesia使得气道在麻醉诱导前得以保护,avoiding the potential risks and consequences of difficult airway management in an anaesthetised patient [30].避免了麻醉患者气道管理困难的潜在风险和后果

Awake tracheal intubation has a favourable safety profile良好的安全性 because both spontaneous ventilation自主呼吸 and intrinsic airway tone 固有气道张力 are maintained保留 until the trachea is intubated[31–35].

Awake tracheal intubation can be unsuccessful in 1–2% of cases, but this rarely leads to airway rescuestrategies or death [33–35]. 清醒插管可能失败，但很少导致气道抢救策略和死亡。

These guidelines aim to increase the use of ATI by providing clear guidance for clinicians to support decision making, preparation andperformance of ATI in the setting of a predicted difficult airway. 这些准则旨在通过为临床医生提供明确的指导，以支持ATI在预测的困难气道设置中的决策、准备和性能，增加ATI的使用。