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Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
Centre for Research & Development, Uppsala University/Region Gävleborg, 801 88 Gävle, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
2016 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, 71Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background

Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure.

Methods

A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories.

Results

From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: 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. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself.

Conclusions

Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

Place, publisher, year, edition, pages
2016. Vol. 16, no 1, 71
Keyword [en]
Awake fiberoptic intubation, Anaesthesia care, Qualitative study
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:hig:diva-21453DOI: 10.1186/s12871-016-0240-zISI: 000382199100004PubMedID: 27576876Scopus ID: 2-s2.0-84984622328OAI: oai:DiVA.org:hig-21453DiVA: diva2:924926
Available from: 2016-03-30 Created: 2016-04-29 Last updated: 2016-11-11Bibliographically approved
In thesis
1. Airway management in anaesthesia care: professional and patient perspectives
Open this publication in new window or tab >>Airway management in anaesthesia care: professional and patient perspectives
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 56 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1205
Keyword
Airway management, algorithm, awake intubation, professional and patient perspective
National Category
Nursing Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
urn:nbn:se:hig:diva-21451 (URN)978-91-554-9534-3 (ISBN)
Public defence
2016-05-20, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2016-04-29Bibliographically approved

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