针对有肺误吸风险患者的安全麻醉：一项全国性调查。

SAFE anaesthesia for patients at risk of pulmonary aspiration: A nationwide survey.

作者信息

Baettig Sascha Jan, Filipovic Mark Georg, Giroud Michele, Bomberg Hagen, Hofer Christoph Karl, Eichenberger Urs, Ganter Michael Thomas

机构信息

From the Institute of Anaesthesiology and perioperative Medicine, University Hospital Zurich, Zurich (SJB), Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern (MGF), Swiss Interest Group for Anaesthesia Nursing (SIGA-FISA), Bern (MG), Institute of Anaesthesiology and Intensive Care Medicine, University Hospital Balgrist, Zurich (HB), Swiss Patient Safety Foundation in Anaesthesia, Institute of Anaesthesiology, Schulthess Clinic Zurich (CKH), Swiss Society for Anaesthesiology and Perioperative Medicine, Institute of Anaesthesiology and Intensive Care Medicine, University Hospital Balgrist (UE), Swiss Society for Anaesthesiology and Perioperative Medicine, Institute of Anaesthesiology and Intensive Care Medicine, Clinic Hirslanden Zurich, Zurich, Switzerland (MTG).

出版信息

Eur J Anaesthesiol Intensive Care. 2025 Mar 10;4(2):e0070. doi: 10.1097/EA9.0000000000000070. eCollection 2025 Apr.

DOI:10.1097/EA9.0000000000000070

PMID:40206342

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11977732/

Abstract

BACKGROUND

Clinical practice in patients at risk of pulmonary aspiration varies widely. However, data on actual management, decision-driving factors and controversial issues remain elusive.

OBJECTIVE

We aimed to comprehensively review the management of patients at risk of pulmonary aspiration and identify controversies among anaesthesia professionals.

DESIGN

National interprofessional survey.

SETTING

All anaesthesia departments in Switzerland.

PARTICIPANTS

The survey was distributed electronically to all members of the Swiss Society of Anaesthesiology and Perioperative Medicine, members of the Swiss Interest Group for Anaesthesia Nursing and all department heads in Switzerland.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Consensus and controversies in clinical practice and management of patients at risk of pulmonary aspiration.

RESULTS

A total of 684 respondents were included in the final analysis (59 department heads, 366 consultants, 99 registrars, 160 nurse anaesthetists). The response rate from physicians was 47%. Consensus (>80% agreement or disagreement) was reached on 9/12 (75%) questions regarding preparation for rapid sequence induction (RSI), 6/13 (46%) regarding RSI practice and 3/8 (38%) regarding management of aspiration incidents. Major controversies included high-flow pre-oxygenation (55% agreement), the validity of modified RSI in adults (52% agreement), the primary use of video-laryngoscope (76% agreement) and management of apparent regurgitation. Subjective factors such as clinical presentation were considered more important than objective factors such as medical history, comorbidities or gastric ultrasound.

CONCLUSION

Across a wide range of experience and professional groups, we found a strong consensus on the indication and performance of 'traditional' RSI. However, clinical decision-making still relies heavily on subjective impressions, while newer risk stratification and management techniques remain controversial.

摘要

背景

有肺误吸风险患者的临床实践差异很大。然而，关于实际管理、决策驱动因素和争议问题的数据仍然难以捉摸。

目的

我们旨在全面回顾有肺误吸风险患者的管理，并确定麻醉专业人员之间的争议。

设计

全国性跨专业调查。

地点

瑞士所有麻醉科。

参与者

该调查以电子方式分发给瑞士麻醉学和围手术期医学协会的所有成员、瑞士麻醉护理兴趣小组的成员以及瑞士所有科室主任。

干预措施

无。

主要观察指标

有肺误吸风险患者临床实践和管理中的共识与争议。

结果

最终分析纳入了684名受访者（59名科室主任、366名顾问、99名住院医生、160名麻醉护士）。医生的回复率为47%。在关于快速顺序诱导（RSI）准备的12个问题中，9个（75%）达成了共识（>80%同意或不同意）；在关于RSI实践的13个问题中，6个（46%）达成了共识；在关于误吸事件管理的8个问题中，3个（38%）达成了共识。主要争议包括高流量预给氧（55%同意）、成人改良RSI的有效性（52%同意）、视频喉镜的主要用途（76%同意）以及明显反流的管理。临床表现等主观因素被认为比病史、合并症或胃超声等客观因素更重要。