Hospital Clínic de Barcelona, Barcelona, España.
Consorci Mar Parc de Salut de Barcelona, Barcelona, España.
Rev Esp Anestesiol Reanim (Engl Ed). 2020 Jun-Jul;67(6):325-342. doi: 10.1016/j.redar.2019.11.011. Epub 2020 May 27.
The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.
加泰罗尼亚麻醉学、重症监护和疼痛管理学会（SCARTD）的气道分部呈现其最新的困难气道评估和管理指南。本次更新纳入了自 2008 年第一版指南发布以来临床实践中观察到的技术进步和变化。该建议由来自 19 家参与医院的专家达成共识制定，并参考了 5 项近期发布的国际指南，对其建议进行深入分析和系统比较后进行了改编。最终文件发送给 SCARTD 的成员进行评估，并由 11 名独立专家进行了审查。因此，这些建议得到了最新科学证据的支持，并得到了该领域专业人士的认可。本版指南对困难气道的定义进行了扩展，包括所有气道管理技术，并强调根据预期的困难程度和额外的安全考虑对气道进行评估和分类，以便规划管理策略。管理前的规划，包括患者和资源的准备，以及优化所有相关专业人员之间的沟通和互动，在所有涉及的情况下都起着关键作用。指南反映了在我们的环境中视频喉镜和第二代设备的使用增加，并提倡在插管时常规使用这些设备，并在遇到意外困难气道时迅速使用。指南还涉及到将超声成像作为评估和决策辅助的使用增加。还纳入了新的场景，如支气管吸入风险和困难拔管。最后，该文件概述了为保证指南的有效和安全实施所需的培训和持续专业发展计划。
