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Vol. 42. Num. 9.December 2018
Pages e23-e28Pages 517-572
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Vol. 42. Num. 9.December 2018
Pages e23-e28Pages 517-572
Original
DOI: 10.1016/j.medine.2018.09.008
National survey on airway and difficult airway management in intensive care units
Encuesta nacional sobre el manejo de la vía aérea y la vía aérea difícil en las unidades de cuidados intensivos
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M.G. Gómez-Prieto, M.R. Míguez-Crespo, J.R. Jiménez-del-Valle, M.D. González-Caro, I. Marmesat-Ríos, J. Garnacho-Montero
Corresponding author
jgarnachom@gmail.com

Corresponding author.
Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Med Intensiva.2018;42:517-810.1016/j.medine.2018.01.012
B. Lobo-Valbuena, F. Gordo
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Figures (1)
Tables (3)
Table 1. Characteristics of the participating Intensive Care Units.
Table 2. Airway management and contents of the difficult airway cart according to Intensive Care Unit size.
Table 3. Airway management and contents of the difficult airway cart according to the presence of an expert in difficult airway.
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Abstract
Objective

To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW).

Design

Descriptive cross-sectional study and χ2 subanalysis, conducted through a national survey from November 1st to December 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs.

Setting

ICUs of public, private centers, and consortia.

Results

In total, 101 units responded (56.4%), corresponding to 1827 beds and almost 95,000 incomes/year. The 85.1% are public hospitals, and 83.2% had residents. Of the responders, 22.8% do not use routinely AW assessment scales, being the most frequently used the Cormack–Mallampati association (35.6%). There is no intubation (IOT) protocol in 77.2%, or DAW protocol in 75.2%. An 82.2% have a DAW cart. The 48.5% have training in IOT, and in VAD 53.5%. Having a DAW expert is significantly associated with greater training in IOT (60% vs. 39.3%; p=0.03), DAW (64.4% vs. 44.6%; p=0.04), and more AW protocols (73.4% vs. 37.5%; p=0.000). Having a specific guideline for DAW management in UCI is considered necessary in 99%.

Conclusions

There is room for improvement in AW management. It is necessary to identify an expert in DAW in each Unit, and the development of a specific guideline for DAW management in critical care.

Keywords:
Airway
Difficult airway
Intubation
Questionnaire
Resumen
Objetivo

Conocer la organización, el manejo y la formación en vía aérea (VA) en las unidades de cuidados intensivos (UCI) españolas, con especial interés en la vía aérea difícil (VAD).

Diseño

Estudio transversal descriptivo y subanálisis con χ2, elaborado mediante una encuesta nacional realizada del 1 de noviembre al 15 de diciembre de 2016. Con el aval de la SEMICYUC, se envió a 179 UCI un cuestionario online con 27 apartados.

Ámbito

UCI de hospitales públicos, privados y consorcios.

Resultados

Responden 101 UCI (56,4%), que suponen 1.827 camas y casi 95.000 ingresos/año. El 85,1% son hospitales públicos, y el 83,2%, con residentes. El 22,8% no utilizan rutinariamente escalas de valoración de VA, siendo la más frecuente la asociación Cormack-Mallampati (35,6%). El 77,2% no tienen protocolo de intubación (IOT), ni el 75,2% protocolo de VAD. El 82,2% tienen carro de VAD. El 48,5% refieren formación en IOT, y el 53,5%, en VAD. Identificar a un experto en VAD se asocia significativamente con mayor formación en IOT (60% vs. 39,3%; p=0,03), VAD (64,4% vs. 44,6%; p=0,04) y más protocolos de VA (73,4% vs. 37,5%; p=0,000). El 99% estima necesario disponer de una guía específica de manejo de VAD en UCI.

Conclusiones

Existe un amplio margen de mejora para el manejo de la VA. Es necesario identificar un experto en VAD en cada unidad y elaborar una guía específica de manejo de VAD en el paciente crítico.

Palabras clave:
Vía aérea
Vía aérea difícil
Intubación
Cuestionario

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