Indication, type of failure, reason for failure and management of eight cases of failed awake tracheal intubation using flexible bronchoscopy (ATI:FB).

Indication, type of failure, reason for failure and management of eight cases of failed awake tracheal intubation using flexible bronchoscopy (ATI:FB).</p

Characteristics of study population and procedural characteristics of awake tracheal intubation using flexible bronchoscopy ATI:FB.

Absolute numbers and percentages. Age (years) and body mass index (BMI) are reported as medians and (IQR, [range]).</p

Odds ratios with 95 % confidence intervals when comparing a specific outcome to a reference category and corresponding p-values for the comparison to the reference category.

Overall p-values for each category are displayed in the category headings. Reference categories have OR = 1 and no confidence interval.</p

Search strategy flow chart: Electric DAQ (internal data acquisition and accounting system) search for ATI:FB (awake tracheal intubation using flexible bronchoscopy) and manual review of the associated anesthesia records.

Search strategy flow chart: Electric DAQ (internal data acquisition and accounting system) search for ATI:FB (awake tracheal intubation using flexible bronchoscopy) and manual review of the associated anesthesia records.</p

STROBE statement—checklist of items that should be included in reports of observational studies.

STROBE statement—checklist of items that should be included in reports of observational studies.</p

S1 Data -

IntroductionWhile awake tracheal intubation (ATI) is regarded as the gold standard for difficult airway management according to current guidelines, there seems to be a reluctance in its application. This retrospective cohort study, conducted at a German tertiary hospital over a 2-year period, aimed to demonstrate that integrating awake tracheal intubation using flexible bronchoscopy (ATI:FB) into routine airway management makes it a successful and safe approach.Materials and methodsIn 2019 and 2020, records from the data acquisition system (DAQ) and archived anesthesia records were screened to evaluate the specifics of ATI:FB procedures, focusing on overall success and safety. Analysis included complications, time required for ATI:FB, and potential influencing factors such as patient characteristics, indication, medical/operative specialty, sedation technique, route and experience of anesthesiologist. Logistic regression assessed the impact of various variables on occurrence of complications and linear regression, with log(time) as the dependent variable, evaluated median time required to perform ATI:FB.ResultsATI:FB constituted 4.3 % (n = 1,911) of all airway management procedures, predominantly observed in dental, oral, and maxillofacial surgery (46.5 %) and otorhinolaryngology (38.4 %). The success rate for ATI:FB was notably high at 99.6 %, with only 5.4 % of cases experiencing complications, including technical issues, agitation, and visibility obstruction due to mucous secretion. Complication risk was influenced by the medical specialty and the experience of the anesthesiologist. A strong effect was observed in otorhinolaryngology (OR = 4.54, 95 % CI [1.64; 14.06]). The median time required for ATI:FB was 16 minutes (IQR: 11 to 23), with factors such as indication (p ConclusionATI:FB proves successful and safe, with low complications and manageable procedural time. Experience of the anesthesiologist is a modifiable factor enhancing safety, emphasizing the need for ATI:FB integration into routine airway management.</div

Purchase of first- (red) and second-generation (turquoise) supraglottic airway devices over time (records of the internal hospital pharmacy).

Purchase of first- (red) and second-generation (turquoise) supraglottic airway devices over time (records of the internal hospital pharmacy).</p

Relative frequency of fibreoptic intubations by specialty.

(otorhinolaryngology = turquoise, dental, oral, and maxillofacial surgery = green, traumatology = purple, neurosurgery = red).</p

Frequency of awake tracheal intubation using flexible bronchoscopy (ATI:FB) by medical/operative specialty, indication, and complication.

Frequency of awake tracheal intubation using flexible bronchoscopy (ATI:FB) by medical/operative specialty, indication, and complication.</p

Marginal mean estimates of time to perform an awake tracheal intubation using flexible bronchoscopy (ATI:FB) adjusted for all covariates in the model.

Explanatory variables were included in multivariable linear regression model for log(time). Results were back transformed to linear time scale. Overall p-values for each category are displayed in the category headings.</p