Journal Club - Recommended Reads

JOURNAL CLUB

| Recommended Reads |

Welcome to the DAS Journal Club - Recommended Reads. Papers are chosen by members of the DAS committee, with short citations/summaries by members of the ezine editorial team. This edition's recommended reads come from Kariem El-Boghdadly with summaries by Moon-Moon Majumdar. We welcome members feedback and thoughts on the papers featured - please tweet us @dastrainees or @dasairway or email us at ezine@das.uk.com.

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

✦ N Chrimes, A Higgs, C A Hagberg, P A Baker, R M Cooper, R Greif, G Kovacs, J A Law, S D

Marshall, S N Myatra, E P O'Sullivan, W H Rosenblatt, C H Ross, J C Sakles, M Sorbello, T M

Cook. DOI: 10.1111/anae.15817

Following the tragic death of Mrs Glenda Logsdail following an unrecognised oesophageal intubation and other similar deaths around the world, this consensus guideline from the Project for Universal Management of Airways (PUMA) is essential reading for every anaesthetist. With contributions from a number of international airway societies, this guideline addresses both technical interventions, strategies to address cognitive biases, and team performance.

Key recommendations include use of exhaled carbon dioxide monitoring and pulse oximetry for all episodes of airway management, routine use of a videolaryngoscope whenever feasible, verbalisation of 'sustained exhaled carbon dioxide' after intubation, and active exclusion of oesophageal intubation if there is not 'sustained exhaled carbon dioxide'. They clarify exact criteria for sustained exhaled carbon dioxide and discuss methods of excluding oesophageal intubation. They also address broader educational requirements to address the team aspects of task performance to implement the guidelines.

Whilst there isn't necessarily a 'results' section to debate or a statistical test to pick apart, the strategies in this guideline are crucial learning for all of us and this certainly warrants discussion in detail at your departmental journal club.

Will your practice change based on this paper?

Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry

✦ Luis Sequera-Ramos, Elizabeth K Laverriere, Annery G Garcia-Marcinkiewicz, Bingqing Zhang,

Pete G Kovatsis, John E Fiadjoe; PeDI Collaborative https://doi.org/10.1097/

ALN.0000000000004353

This October 2022 study uses data from from the international Pediatric Difficult Intubation Registry, which prospectively collects data about tracheal intubation in children with difficult airways and compares sedation versus general anaesthesia (GA) in these patients. Whilst sedated/awake tracheal intubation approaches are considered safest in adults with difficult airways, we know very little about the outcomes of sedated intubations in children.

This study compares sedation and GA for their primary outcome of first-attempt success of tracheal intubation in children. There is lots to learn from this article, both about airway management and study design: what do you think are the limitations of this paper? What does 'sedation' here actually mean? This study is the starting point of some fascinating discussion and we would love to hear what transpired from your journal club: tweet us @dastrainees or email ezine@das.uk.com