Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies.

Chrimes, N; Higgs, A; Hagberg, C A; Baker, P A; Cooper, R M; Greif, R; Kovacs, G; Law, J A; Marshall, S D; Myatra, S N; O'Sullivan, E P; Rosenblatt, W H; Ross, C H; Sakles, J C; Sorbello, M; Cook, T M (2022). Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia, 77(12), pp. 1395-1415. Association of Anaesthetists 10.1111/anae.15817

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Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occur in the hands of both inexperienced and experienced practitioners. Current evidence shows that unrecognised oesophageal intubation occurs sufficiently frequently to be a major concern and to merit a co-ordinated approach to address it. Harm from unrecognised oesophageal intubation is avoidable through reducing the rate of oesophageal intubation, combined with prompt detection and immediate action when it occurs. The detection of 'sustained exhaled carbon dioxide' using waveform capnography is the mainstay for excluding oesophageal placement of an intended tracheal tube. Tube removal should be the default response when sustained exhaled carbon dioxide cannot be detected. If default tube removal is considered dangerous, urgent exclusion of oesophageal intubation using valid alternative techniques is indicated, in parallel with evaluation of other causes of inability to detect carbon dioxide. The tube should be removed if timely restoration of sustained exhaled carbon dioxide cannot be achieved. In addition to technical interventions, strategies are required to address cognitive biases and the deterioration of individual and team performance in stressful situations, to which all practitioners are vulnerable. These guidelines provide recommendations for preventing unrecognised oesophageal intubation that are relevant to all airway practitioners independent of geography, clinical location, discipline or patient type.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Greif, Robert

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1365-2044

Publisher:

Association of Anaesthetists

Language:

English

Submitter:

Pubmed Import

Date Deposited:

18 Aug 2022 09:25

Last Modified:

05 Dec 2022 16:22

Publisher DOI:

10.1111/anae.15817

PubMed ID:

35977431

Uncontrolled Keywords:

airway management capnography human factors oesophageal intubation tracheal intubation

BORIS DOI:

10.48350/172148

URI:

https://boris.unibe.ch/id/eprint/172148

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