Zhi-hang Tang MD , Qi Chen MD , Wei Huang MD , Jia-nan Wang MD , Xiao-hua Zou PhD , Yang Xiao PhD , Xiao-tong Shi PhD , Hai-hong Deng PhD , Jing-jing Li PhD , Lun Wu PhD , Wen-zhi Liu PhD , Si-guang Hu PhD , Zheng-yang Zhou PhD , Heng-ning Qi PhD , Guo-hui Luan Phd , Wei Luo PhD , Yong Wang PhD , Wu-hua Ma Phd
{"title":"Difficult airway management in 25 hospitals across China: A multicenter cross-sectional study","authors":"Zhi-hang Tang MD , Qi Chen MD , Wei Huang MD , Jia-nan Wang MD , Xiao-hua Zou PhD , Yang Xiao PhD , Xiao-tong Shi PhD , Hai-hong Deng PhD , Jing-jing Li PhD , Lun Wu PhD , Wen-zhi Liu PhD , Si-guang Hu PhD , Zheng-yang Zhou PhD , Heng-ning Qi PhD , Guo-hui Luan Phd , Wei Luo PhD , Yong Wang PhD , Wu-hua Ma Phd","doi":"10.1016/j.jclinane.2025.111766","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><div>Difficult airway management is a significant challenge in clinical anesthesia, critical care, and emergency medicine. Inadequate management can lead to severe complications including organ damage and death. This study assessed the variability in difficult airway management across China and focused on how patient and operator factors influenced outcomes in operating rooms.</div></div><div><h3>Design</h3><div>A multicenter observational cross-sectional study.</div></div><div><h3>Setting</h3><div>This study was conducted from November 2022 to November 2023 and included 25 secondary and tertiary hospitals across various regions in China.</div></div><div><h3>Patients</h3><div>In the total of 181,399 general anesthesia patients, 384 (0.21 %) were identified as having difficult airways.</div></div><div><h3>Interventions</h3><div>Data were gathered from a specialized questionnaire comprising four sections with 27 questions and analyzed using logistic regression in SPSS to identify key factors that influenced effective management of difficult airways.</div></div><div><h3>Measurements</h3><div>This study focused on preoperative assessment, anesthesia selection, intubation attempts, and contingency planning for difficult airway management practices among anesthesiologists.</div></div><div><h3>Main results</h3><div>In anticipated difficult airways, rapid sequence induction was used in 51.7 % of the cases, maintaining spontaneous breathing under general anesthesia in 11.1 %, and awake intubation in 36 %. For unanticipated difficult airways, 95.9 % of the anesthesiologists opted for rapid sequence induction. Limited mouth opening was the most common cause of difficult airways and obesity and ankylosing spondylitis were identified as significant factors. The logistic regression analysis identified the type of difficult airway, anesthesiologist experience, and assessment methods as key factors influencing the first attempt intubation success.</div></div><div><h3>Conclusions</h3><div>The accuracy of difficult airway assessment and first attempt intubation success is influenced by both patient-related factors and the anesthesiologist's expertise. Regional and institutional variability in decision-making and tool selection underscores the critical need for standardized guidelines and comprehensive training to enhance airway management outcomes across diverse clinical settings in China.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111766"},"PeriodicalIF":5.0000,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818025000261","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study objective
Difficult airway management is a significant challenge in clinical anesthesia, critical care, and emergency medicine. Inadequate management can lead to severe complications including organ damage and death. This study assessed the variability in difficult airway management across China and focused on how patient and operator factors influenced outcomes in operating rooms.
Design
A multicenter observational cross-sectional study.
Setting
This study was conducted from November 2022 to November 2023 and included 25 secondary and tertiary hospitals across various regions in China.
Patients
In the total of 181,399 general anesthesia patients, 384 (0.21 %) were identified as having difficult airways.
Interventions
Data were gathered from a specialized questionnaire comprising four sections with 27 questions and analyzed using logistic regression in SPSS to identify key factors that influenced effective management of difficult airways.
Measurements
This study focused on preoperative assessment, anesthesia selection, intubation attempts, and contingency planning for difficult airway management practices among anesthesiologists.
Main results
In anticipated difficult airways, rapid sequence induction was used in 51.7 % of the cases, maintaining spontaneous breathing under general anesthesia in 11.1 %, and awake intubation in 36 %. For unanticipated difficult airways, 95.9 % of the anesthesiologists opted for rapid sequence induction. Limited mouth opening was the most common cause of difficult airways and obesity and ankylosing spondylitis were identified as significant factors. The logistic regression analysis identified the type of difficult airway, anesthesiologist experience, and assessment methods as key factors influencing the first attempt intubation success.
Conclusions
The accuracy of difficult airway assessment and first attempt intubation success is influenced by both patient-related factors and the anesthesiologist's expertise. Regional and institutional variability in decision-making and tool selection underscores the critical need for standardized guidelines and comprehensive training to enhance airway management outcomes across diverse clinical settings in China.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.