Исследование Difficult Airway Society

[cactus1972]

В майском номере British Journal of Anesthesia опубликованы результаты исследования причин осложнений и неудач при обеспечении проходимости дыхательных путей, проведенного Royal College of Anaesthetists and Difficult Airway Society

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Кратко - результаты исследования. Некоторые цифры и выводы заставляют задуматься.

Of 184 reports meeting inclusion criteria, 133 related to general anaesthesia: 46 events per million general anaesthetics [95% confidence interval (CI) 38–54] or one per 22 000 (95% CI 1 per 26–18 000). Anaesthesia events led to 16 deaths and three episodes of persistent brain damage: a mortality rate of 5.6 per million general anaesthetics (95% CI 2.8–8.3): one per 180 000 (95% CI 1 per 352–120 000). These estimates assume that all such cases were captured. Rates of death and brain damage for different airway devices (facemask, supraglottic airway, tracheal tube) varied little. Airway management was considered good in 19% of assessable anaesthesia cases. Elements of care were judged poor in three-quarters: in only three deaths was airway management considered exclusively good.

Таким образом, хотя частота осложнений, в т.ч. летальных исходов, обусловленных проблемами в обеспечении проходимости дыхательных путей во время анестезии, невелика (46 случаев на 1000000 анестезий; 16 летальных исходов, т.е. 5,6 на 1000000 анестезий), только в 19% случаев мероприятия по обеспечению проходимости дыхательных путей были проведены в полном объеме. В случаях, закончившихся летальным исходом, только у 3-х пациентов были соблюдены все необходимые меры.

В исследовании проведен анализ условий и причин развития осложнений

Important findings related to anaesthesia cases in this project include: (i) more than half of the patients were male, ASA I–II, aged <60, and most events occurred during elective surgery under the care of anaesthetic consultants. (ii) Aspiration was the most frequent cause of anaesthesia airway-related mortality. (iii) Obese patients were disproportionately represented. (iv) Obstructing airway lesions generated a large number of complications, many reports showed evidence of poor planning of primary and rescue techniques. (v) Cricothyroidotomy by anaesthetists was associated with a high rate of failure. (vi) One in four events occurred at the end of anaesthesia or in the early recovery room. (vii) Omission or incorrect interpretation of capnography led to undiagnosed oesophageal intubation. (viii)...

Один из главных выводов, на который стОит обратить особое внимание:

Elements of poor management were observed in the majority of airway complications and most deaths.