Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

Anders Kehlet Nørskov; J Wetterslev; C V Rosenstock; A Afshari; G Astrup; J C Jakobsen; J L Thomsen; M Bøttger; Marguerite Ellekvist; Birgitte Marie Bonne Schousboe; A Horn; B G Jørgensen; K Lorentzen; M H Madsen; J S Knudsen; B K Thisted; S Estrup; H B Mieritz; T Klesse; H Martinussen; Anne Grønborg Vedel; R Maaløe; Karin Birgit Bøsling; P R C Kirkegaard; C R Ibáñez; G Aleksandraviciute; L S Hansen; T Mantoni; Lars Hyldborg Lundstrøm

doi:10.1093/bja/aew057

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

Anders Kehlet Nørskov, J Wetterslev, C V Rosenstock, A Afshari, G Astrup, J C Jakobsen, J L Thomsen, M Bøttger, Marguerite Ellekvist, Birgitte Marie Bonne Schousboe, A Horn, B G Jørgensen, K Lorentzen, M H Madsen, J S Knudsen, B K Thisted, S Estrup, H B Mieritz, T Klesse, H MartinussenAnne Grønborg Vedel, R Maaløe, Karin Birgit Bøsling, P R C Kirkegaard, C R Ibáñez, G Aleksandraviciute, L S Hansen, T Mantoni, Lars Hyldborg Lundstrøm

67 Citations (Scopus)

Abstract

BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.

METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.

RESULTS: A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).

CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.

CLINICAL TRIAL REGISTRATION: NCT01718561.

Original language	English
Journal	British Journal of Anaesthesia
Volume	116
Issue number	5
Pages (from-to)	680-9
Number of pages	10
ISSN	0007-0912
DOIs	https://doi.org/10.1093/bja/aew057
Publication status	Published - May 2016

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Kehlet Nørskov, A., Wetterslev, J., Rosenstock, C. V., Afshari, A., Astrup, G., Jakobsen, J. C., Thomsen, J. L., Bøttger, M., Ellekvist, M., Schousboe, B. M. B., Horn, A., Jørgensen, B. G., Lorentzen, K., Madsen, M. H., Knudsen, J. S., Thisted, B. K., Estrup, S., Mieritz, H. B., Klesse, T., ... Lundstrøm, L. H. (2016). Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants. British Journal of Anaesthesia, 116(5), 680-9. https://doi.org/10.1093/bja/aew057

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants. / Kehlet Nørskov, Anders; Wetterslev, J; Rosenstock, C V et al.
In: British Journal of Anaesthesia, Vol. 116, No. 5, 05.2016, p. 680-9.

Research output: Contribution to journal › Journal article › Research › peer-review

Kehlet Nørskov, A, Wetterslev, J, Rosenstock, CV , Afshari, A, Astrup, G, Jakobsen, JC, Thomsen, JL, Bøttger, M , Ellekvist, M, Schousboe, BMB, Horn, A, Jørgensen, BG, Lorentzen, K, Madsen, MH, Knudsen, JS, Thisted, BK, Estrup, S, Mieritz, HB, Klesse, T, Martinussen, H, Vedel, AG, Maaløe, R, Bøsling, KB, Kirkegaard, PRC, Ibáñez, CR, Aleksandraviciute, G, Hansen, LS, Mantoni, T & Lundstrøm, LH 2016, 'Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants', British Journal of Anaesthesia, vol. 116, no. 5, pp. 680-9. https://doi.org/10.1093/bja/aew057

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title = "Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants",

abstract = "BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.RESULTS: A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4\% (696) of the participants had an unanticipated difficult intubation vs 2.4\% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95\% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42\% (415) in SARI departments vs 1.00\% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.CLINICAL TRIAL REGISTRATION: NCT01718561.",

author = "\{Kehlet N{\o}rskov\}, Anders and J Wetterslev and Rosenstock, \{C V\} and A Afshari and G Astrup and Jakobsen, \{J C\} and Thomsen, \{J L\} and M B{\o}ttger and Marguerite Ellekvist and Schousboe, \{Birgitte Marie Bonne\} and A Horn and J{\o}rgensen, \{B G\} and K Lorentzen and Madsen, \{M H\} and Knudsen, \{J S\} and Thisted, \{B K\} and S Estrup and Mieritz, \{H B\} and T Klesse and H Martinussen and Vedel, \{Anne Gr{\o}nborg\} and R Maal{\o}e and B{\o}sling, \{Karin Birgit\} and Kirkegaard, \{P R C\} and Ib{\'a}{\~n}ez, \{C R\} and G Aleksandraviciute and Hansen, \{L S\} and T Mantoni and Lundstr{\o}m, \{Lars Hyldborg\}",

year = "2016",

month = may,

doi = "10.1093/bja/aew057",

language = "English",

volume = "116",

pages = "680--9",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier Limited",

number = "5",

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TY - JOUR

T1 - Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

AU - Kehlet Nørskov, Anders

AU - Wetterslev, J

AU - Rosenstock, C V

AU - Afshari, A

AU - Astrup, G

AU - Jakobsen, J C

AU - Thomsen, J L

AU - Bøttger, M

AU - Ellekvist, Marguerite

AU - Schousboe, Birgitte Marie Bonne

AU - Horn, A

AU - Jørgensen, B G

AU - Lorentzen, K

AU - Madsen, M H

AU - Knudsen, J S

AU - Thisted, B K

AU - Estrup, S

AU - Mieritz, H B

AU - Klesse, T

AU - Martinussen, H

AU - Vedel, Anne Grønborg

AU - Maaløe, R

AU - Bøsling, Karin Birgit

AU - Kirkegaard, P R C

AU - Ibáñez, C R

AU - Aleksandraviciute, G

AU - Hansen, L S

AU - Mantoni, T

AU - Lundstrøm, Lars Hyldborg

PY - 2016/5

Y1 - 2016/5

N2 - BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.RESULTS: A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.CLINICAL TRIAL REGISTRATION: NCT01718561.

AB - BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment.METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation.RESULTS: A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation was 1.42% (415) in SARI departments vs 1.00% (302) in Non-SARI departments. Adjusted OR was 1.26 (0.68-2.34).CONCLUSIONS: Using the SARI compared with usual airway assessment we detected no statistical significant changes in unanticipated difficult- or easy intubations.CLINICAL TRIAL REGISTRATION: NCT01718561.

UR - https://www.scopus.com/pages/publications/84965147481

U2 - 10.1093/bja/aew057

DO - 10.1093/bja/aew057

M3 - Journal article

C2 - 27106972

SN - 0007-0912

VL - 116

SP - 680

EP - 689

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 5

ER -

Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

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