背景:轻微的不良气道事件在气道管理的安全性中起着关键作用。改变气道管理策略可以减少此类事件,但对气道管理的更广泛影响尚不清楚.
方法:次要,在实施气道管理策略变更前后,对经常发生的不良气道事件进行了审核.我们使用两个贝叶斯网络来检查后续气道事件的条件概率,并计算某些事件发生的可能性。
结果:与性别无关,年龄,和美国麻醉医师协会的身体状况,气道管理策略的针对性改变降低了首次事件的风险.肥胖患者是个例外,没有实现风险降低的人。确定了经常发生的事件序列,例如,最可能发生的事件是Cormack-Lehane≥3级,风险为14.3%(95%可信间隔[CI],11.4-17.2%)。检测到目标变化对某些事件序列可能性的影响,例如,气管导管相关事件发生后无连续事件发生的可能性从43.3%(95%CI,39.4~47.6%)增加至56.4%(95%CI,52.0~60.5%).
结论:识别事件序列的风险模式和典型结构提供了气道事件的临床相关观点。其进一步提供了量化目标气道管理改变的影响的手段。这些有针对性的变化会影响一些事件序列,但总的来说,受益来自多个事件改善的累积效应.具有风险模式和事件序列知识的针对性气道管理改变可以潜在地进一步提高气道管理中的患者安全性。
背景:NCT02743767。
Minor adverse airway events play a pivotal role in the safety of airway management. Changes in airway management strategies can reduce such events, but the broader impact on airway management remains unclear.
Minor, frequently occurring adverse airway events were audited before and after implementation of changes to airway management strategies. We used two Bayesian networks to examine conditional probabilities of subsequent airway events and to compute the likelihood of certain events given that certain previous events occurred.
Independent of sex, age, and American Society of Anesthesiologists physical status, targeted changes to airway management strategies reduced the risk of a first event. Obese patients were an exception, in whom no risk reduction was achieved. Frequently occurring event sequences were identified, for example the most likely event to follow difficult bag-mask ventilation was a Cormack-Lehane grade ≥3, with a risk of 14.3% (95% credible interval [CI], 11.4-17.2%). An impact of the targeted changes was detected on the likelihood of some event sequences, for example the likelihood of no consecutive event after a tracheal tube-related event increased from 43.3% (95% CI, 39.4-47.6%) to 56.4% (95% CI, 52.0-60.5%).
Identification of risk patterns and typical structures of event sequences provides a clinically relevant perspective on airway incidents. It further provides a means to quantify the impact of targeted airway management changes. These targeted changes can influence some event sequences, but overall, the benefit results from the cumulative effect of improvements in multiple events. Targeted airway management changes with knowledge of risk patterns and event sequences can potentially further improve patient safety in airway management.
NCT02743767.