Features of airway management procedures - an audit in tertiary care hospital in Lithuania
Karbonskienė A., Grauslytė L., Masiliūnienė G., Macas A.
Clinic of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Background and Goal of Study: Problems of airway management can result in severe consequences despite technological and educational advances in airway management techniques. We attempted to audit airway management procedures at our institution (tertiary care teaching facility, Hospital of Lithuanian University of Health Sciences, HLUHS) in order to suggest further training opportunities for the staff and plan acquirement of devices for advanced airway management. 
Materials and Methods: Prospective observational study of 1 month period (November 23rd-December 23rd, 2015). Using a standardized proforma we collected data on tracheal intubation procedures. Data included location, patient characteristics, results of airway evaluation, training grade and affiliation of intubator, assistance present, details of technique and adverse events. 
Results: Data was collected for 1041 tracheal intubations. 825 (79,3%) patients were graded as having no probability of difficult airway management (group I), borderline predicted intubation difficulty was found in 192 (18,4%) (group II) and severe predicted intubation difficulty in 24 (2,3%) patients (group III). Primary intubation technique is shown in table 1. 
Patients' groups according to predicted difficulty of intubation	Primary intubation technique (n of cases, %)
 	Direct laryngoscopy	Videolaryngoscopy	Flexible fiberscopy
I	781 (94,7%)	21 (2,5%)	23 (2,8%)
II	169 (88,0%)	9 (4,7%)	14 (7,3%)
III	14 (58,3%)	4(16,7%)	6(25%)
[ Table1. Primary intubation technique]

A total of 109 airway-related events were reported. Incidence of airway events was 7,9% in patients of group I, 18,2% of group II and 37,5% of group III. There were 3 aspirations, two patients required a surgical airway. No deaths due to airway management were registered during study period.
Conclusion: Usage of advanced airway techniques is still scarce in HLUHS, especially in cases predicted airway management difficulty. Further training and acquirement of airway management devices is warranted.

Features of airway management procedures – an audit in tertiary care hospital in Lithuania