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How anaesthesiologists understand difficult airway guidelines: an interview study
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.ORCID-id: 0000-0002-6960-270X
Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap.
Institutionen för hälsovetenskaper, Örebro universitet .ORCID-id: 0000-0002-2867-0490
Uppsala universitet, Institutionen för medicinska vetenskaper.ORCID-id: 0000-0002-6392-6092
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2017 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 4, s. 243-248Artikel i tidskrift (Refereegranskat) Published
Resurstyp
Text
Abstract [en]

Background: In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms.

Methods: A qualitative phenomenographic design was chosen to explore anaesthesiologists’ views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted.

Results: Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts’ consensus, a set of scientifically based guidelines for handling the difficult airway.

Conclusions: The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently.

Ort, förlag, år, upplaga, sidor
2017. Vol. 122, nr 4, s. 243-248
Nyckelord [en]
Airway guidelines, algorithms, qualitative study
Nationell ämneskategori
Anestesi och intensivvård
Identifikatorer
URN: urn:nbn:se:hig:diva-21452DOI: 10.1080/03009734.2017.1406020ISI: 000423294800006PubMedID: 29299973Scopus ID: 2-s2.0-85041236643OAI: oai:DiVA.org:hig-21452DiVA, id: diva2:924924
Projekt
Patientsäkerhet och omvårdnad i samband med anestesi med fokus på luftvägen
Forskningsfinansiär
Hjärt-LungfondenTillgänglig från: 2016-03-30 Skapad: 2016-04-29 Senast uppdaterad: 2020-01-24Bibliografiskt granskad
Ingår i avhandling
1. Airway management in anaesthesia care: professional and patient perspectives
Öppna denna publikation i ny flik eller fönster >>Airway management in anaesthesia care: professional and patient perspectives
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Careful airway management, including tracheal intubation, is important when performing anaesthesia in order to achieve safe tracheal intubation. Aim: To study airway management in anaesthesia care from both the professional and patient perspectives. Methods: 11 RNAs performed three airway tests in 87 patients, monitored in a study-specific questionnaire. The tests usefulness for predicting an easy intubation was analysed (Study I). 68 of 74 anaesthesia departments in Sweden answered a self-reported questionnaire about the presence of airway guidelines (Study II). 20 anaesthesiologists were interviewed; a phenomenographic analysis was performed to describe how anaesthesiologists' understand algorithms for management of the difficult airway (Study III). 13 patients were interviewed; content analysis was performed to describe patients' experiences of being awake fiberoptic intubated (Study IV). Results: The Mallampati classification is a good screening test for predicting easy intubation and intubation can be safely performed by RNAs (Study I). The presence of airway guidelines in Swedish anaesthesia departments is poorly implemented (Study II). Algorithms can be understood as law-like rules, a succinct plan to follow in difficult airway situations, an action plan kept in the back of one's mind while creating flexible and versatile personal algorithms, or as consensus guidelines based on expert opinion in order to be followed in clinical practice (Study III). One theme emerged describing experiences of being awake intubated; feelings of being in a vulnerable situation but cared for in safe hands, described in five categories: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation (Study IV). Conclusions: The Mallampati classification is a good screening test for predicting easy intubation, when the airway assessment is performed in a structured manner by RNAs. The presence of airway guidelines in Swedish anaesthesia departments was poorly implemented and should receive higher priority. Algorithms need to be simple and easy to follow and based on the best available scientific evidence. Tailored information about what to expect, ensuring eye contact, and giving breathing instructions during the procedure may reduce patients' feeling distress.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2016. s. 56
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1205
Nyckelord
Airway management, algorithm, awake intubation, professional and patient perspective
Nationell ämneskategori
Omvårdnad Anestesi och intensivvård
Identifikatorer
urn:nbn:se:hig:diva-21451 (URN)978-91-554-9534-3 (ISBN)
Disputation
2016-05-20, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, 13:00 (Svenska)
Opponent
Handledare
Projekt
Patientsäkerhet och omvårdnad i samband med anestesi med fokus på luftvägen
Tillgänglig från: 2016-04-29 Skapad: 2016-04-29 Senast uppdaterad: 2020-03-25Bibliografiskt granskad

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Knudsen, KatiNilsson, UlricaHögman, Marieann

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