Ghosh Parineeta, Ward Patrick A, Orrock Jane L, Greif Robert, McNarry Alistair F
From the North West School of Anaesthesia, UK (PG), Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, Scotland (PAW, JLO, AFM), Faculty of Medicine, University of Bern, Bern, Switzerland (RG) and Department of Surgical Science, University of Turin, Turin, Italy (RG).
Eur J Anaesthesiol. 2025 Apr 1;42(4):357-365. doi: 10.1097/EJA.0000000000002128. Epub 2025 Jan 30.
Apnoeic oxygenation using high-flow nasal oxygen is becoming a commonly used technique in adult patients undergoing laryngotracheal surgery. Despite widespread adoption, there are no best practice guidelines governing its safe delivery.
To develop a checklist for use during laryngotracheal surgery to guide the safe delivery of apnoeic oxygenation using high-flow nasal oxygen.
Recognised experts in the field of apnoeic oxygenation were invited to participate in a Delphi process to establish essential items for inclusion in the safety checklist. An online Delphi survey platform was used to facilitate this process.
A panel of 36 experts was assembled from 11 countries. They participated voluntarily in an 8-week Delphi process that included one preliminary round, two electronic voting rounds and a final virtual roundtable discussion. A small steering group was responsible for leading the Delphi process, collating the electronic voting responses, analysing the results and compiling the final checklist.
The consensus threshold for inclusion/exclusion of items in the safety checklist was set at at least 80% for the first and second electronic voting rounds. The consensus threshold was set at 70% for the final roundtable discussion.
The final checklist comprises 19 items, sub-divided into pre-procedure, peri-procedure and post-procedure aspects of patient care. The Delphi process was well attended, with an expert attrition rate of only 6%. A number of items reached more than 90% consensus, including the requirement to establish patients' suitability for the technique in advance of surgery and preparedness for the immediate implementation of an agreed individualised rescue oxygenation strategy.
A Delphi process involving international experts has formulated a 19-item checklist for guiding the safe delivery of apnoeic oxygenation using high-flow nasal oxygen in adult patients undergoing laryngotracheal surgery. Further studies are required to assess the effects of this checklist on patient safety and outcomes.
在接受喉气管手术的成年患者中，使用高流量鼻导管吸氧进行无呼吸氧合正成为一种常用技术。尽管该技术已被广泛采用，但尚无关于其安全实施的最佳实践指南。
制定一份在喉气管手术期间使用的检查表，以指导使用高流量鼻导管吸氧进行无呼吸氧合的安全实施。
邀请无呼吸氧合领域的知名专家参与德尔菲法，以确定安全检查表中应包含的基本项目。使用在线德尔菲调查平台来推动这一过程。
由来自11个国家的36名专家组成一个小组。他们自愿参与了为期8周的德尔菲过程，该过程包括一轮初步轮次、两轮电子投票轮次和一次最终的虚拟圆桌讨论。一个小型指导小组负责领导德尔菲过程，整理电子投票回复，分析结果并编制最终检查表。
安全检查表中项目纳入/排除的共识阈值在第一轮和第二轮电子投票中设定为至少80%。最终圆桌讨论的共识阈值设定为70%。
最终检查表包含19项内容，分为患者护理的术前、术中及术后方面。德尔菲过程参与度很高，专家流失率仅为6%。许多项目达成了超过90%的共识，包括在手术前确定患者是否适合该技术以及为立即实施商定的个体化救援氧合策略做好准备的要求。
一项涉及国际专家的德尔菲过程制定了一份包含19项内容的检查表，用于指导在接受喉气管手术的成年患者中使用高流量鼻导管吸氧进行无呼吸氧合的安全实施。需要进一步研究来评估该检查表对患者安全和结局的影响。
