Approaches to the management of difficult airways in adults

Abstract

Airway management is a core competency in anaesthesia, critical care and emergency medicine and a crucial task for these medical specialties. Problems with airway management and subsequent inadequate ventilation of the lungs can rapidly lead to hypoxia, hypoxic brain injury or death. It is known that problems with airway management contribute significantly to morbidity and mortality in anaesthesia.

The presented work comprises a series of trials that investigated a variety of different approaches to the management of difficult airways in adults. The trials were mostly randomized controlled clinical trials. Areas of research included the use of tools for tracheal intubation such as rigid scopes and videolaryngoscopes, the use of supraglottic airway devices, and the use of ultrasound for front of neck access.

Rigid scopes were shown to be highly successful for tracheal intubation in patients with a simulated difficult airway. They also proved useful for intubation of spontaneously breathing patients under conscious sedation. We identified clinically important differences with regard to the performance of different videolaryngoscopes and showed that in the hands of experienced anaesthetists an added channel for tube guidance does not seem to improve the success of videolaryngoscopes. The publications on supraglottic airway devices assessed performance, risk factors for device failure, and describe a rare complication of supraglottic airway devices. The use of ultrasound was assessed as an aid to identify the tracheal midline for front of neck access.

The results of the trials provide a foundation for an evidence-based choice of airway devices and management strategies. Future research will focus on the implementation of research data and new techniques into clinical practice, improvement of institutional airway management strategies, and new techniques such as clinical applications of high flow humidified oxygen.

Date of Award	Aug 2018
Original language	English
Awarding Institution	University of Portsmouth
Supervisor	Graham Mills (Supervisor)