Endotracheal Intubation Complication

This observational study focuses on children under 18 years of age with tracheostomies who are followed at the Long-Term Intensive Care Unit (LIVA) at Karolinska University Hospital in Sweden. It aims to determine how often tracheostomy-related airway complications are asymptomatic or linked to symptoms detected through surveillance airway endoscopy. Additionally, the study evaluates how accurately caregivers and pediatricians can identify symptoms related to serious airway complications. Children scheduled for regular surveillance airway endoscopy under anesthesia as part of their follow-up at LIVA will be included. Upon admission, caregivers complete a questionnaire about possible symptoms of airway complications. The child then undergoes a physical exam and medical history review by a pediatrician following a set protocol. An ENT surgeon, unaware of the questionnaire and pediatrician exam results, performs the airway endoscopy to identify complications. During the study, researchers will compare caregiver and pediatrician reports with findings from airway endoscopy to assess symptom reliability. The main measurements include the proportion of patients with serious tracheostomy airway complications who show no symptoms before endoscopy. The study spans two years, with ongoing surveillance and the collection of data on symptoms and complications. Ethical approval has been obtained to conduct this research.

Researchers are evaluating a new multi-component score called the Readiness for EXtubation score (REXs) to predict when ICU patients on invasive mechanical ventilation are ready to be extubated. The process of liberation from mechanical ventilation involves weaning, readiness assessment, and extubation, with success defined as not needing invasive support within 48 hours. This study focuses on developing and analyzing REXs to help clinicians assess extubation readiness more accurately in critically ill patients. The study involves daily screening of ICU patients undergoing weaning from invasive mechanical ventilation. Data collected include clinical parameters such as arterial blood gases, ventilation settings, sedation and agitation scores, heart rate, hemoglobin levels, nutritional status, and cough strength, among others. Clinicians will anonymously enter data into an electronic case report form to develop and evaluate the REXs score. Patients prepared for extubation will have their readiness assessed using this score. Participants will be monitored during their ICU stay, with data collected on extubation success or failure at 24, 48, and 72 hours after extubation. Researchers will also track length of ICU and hospital stays and mortality outcomes. The study uses routine clinical data, with anonymization to protect patient confidentiality. Statistical methods will analyze associations between clinical factors and extubation outcomes to validate the REXs score’s predictive ability. The total study duration extends until the end of 2026.

Many newborn babies experience breathing difficulties that require intubation, a procedure where a tube is inserted into the windpipe to help with breathing support. This trial compares two methods used by doctors to perform intubation: the traditional direct laryngoscopy (DL), where doctors look directly into the baby's mouth with a standard laryngoscope, and video laryngoscopy (VL), which uses a camera and screen to view the windpipe. The study aims to determine if VL leads to more successful first attempts without causing drops in oxygen levels or heart rate compared to DL. The trial uses a stepped-wedge cluster randomized design across multiple hospitals. Initially, each hospital uses the standard DL method for intubation. At randomly assigned intervals, hospitals switch to using the VL device, the C-MAC video laryngoscope, which includes a monitor and special blades. Doctors receive training and practice with this device before switching. Other intubation practices, such as drug use and supplemental oxygen, remain the same throughout the study. Participants in the trial are newborn infants undergoing intubation. Researchers will collect information about intubation attempts, including success rates, oxygen levels, heart rates, and any complications like oral trauma or need for chest compressions. The main outcome is whether babies are successfully intubated on the first try without physiological instability within five minutes. Additional measures include procedure time, number of attempts, and adverse events. Data will be compared between the periods using DL and VL to assess effectiveness and safety over the course of the study, which lasts until August 2026.

Researchers are comparing the effects of xylometazoline nasal drops and adrenaline nasal packing on nasal bleeding during nasotracheal intubation in participants undergoing elective oromaxillofacial surgeries. The trial aims to determine which of these two treatments better reduces nasal bleeding during the procedure. This study includes participants aged 18 to 60 years with specific health criteria to ensure safety and accuracy. Participants are randomly assigned to one of two groups. One group receives 0.1% xylometazoline nasal drops, administered as 3 to 5 drops in the selected nostril 15 minutes before surgery. The other group receives adrenaline nasal packing, where a gauze soaked in adrenaline is placed inside the nostril 15 minutes before surgery and removed after 7 to 10 minutes. Both groups undergo nasotracheal intubation under general anesthesia with careful monitoring. Throughout the study, participants will have vital signs monitored, including blood pressure, heart rate, ECG, and oxygen saturation. An experienced anesthesiologist will perform the procedures and record the incidence and severity of nasal bleeding during intubation and extubation. Data will be analyzed to compare bleeding outcomes between groups while considering factors like age, gender, and medical history. Participation lasts through the surgical procedure and immediate recovery monitoring.

Researchers are investigating how clinical and ultrasound measurements can help predict the best videolaryngoscopy strategy for adults undergoing intubation during anesthesia or critical care. This observational, multicenter study aims to analyze data using artificial intelligence, including statistical and machine-learning methods, to understand how these measurements relate to videolaryngoscopy outcomes. The goal is to develop decision-support tools to assist clinicians, though these tools will not replace medical judgment. The study collects clinical parameters, demographic information, and point-of-care airway ultrasound measurements from adult patients undergoing general anesthesia with videolaryngoscopy intubation. Various ultrasound measurements, such as distances from skin to anatomical landmarks and tongue thickness, are taken immediately before anesthesia induction. Additional clinical airway assessments like the Modified Mallampati Score and neck circumference are also recorded. Participants will undergo ultrasound and clinical airway evaluations before anesthesia induction. Researchers will measure specific distances and thicknesses with ultrasound probes and record physical airway assessment scores. The study will analyze these results to predict difficult videolaryngoscopy. Data collection supports the creation of predictive models, and participant involvement lasts through the scheduled surgery requiring intubation, with no treatment or intervention changes required.

Researchers are conducting a unicentric observational study to collect clinical, demographic, and airway ultrasound data from patients undergoing videolaryngoscopy during general anesthesia. The study aims to analyze these variables using machine learning to understand their relationship with videolaryngoscopy outcomes, such as blade performance and the need for additional tools. The goal is to develop a predictive model to assist in planning videolaryngoscopy strategies, intended for research and decision support without replacing clinician judgment. Participants undergoing scheduled surgery that requires orotracheal intubation will have various clinical airway assessments and point-of-care ultrasound measurements performed. These include distances measured with linear and convex ultrasound probes, alongside clinical tests like the Modified Mallampati Score, thyromental and sternomental distances, interincisor distance, upper lip bite test, and neck circumference. Data are collected during the intubation procedure for analysis. During the study, participants will undergo ultrasound and clinical airway evaluations taking a few minutes each. Researchers will measure distances to airway structures and perform bedside airway tests. These measures will be monitored to develop a model predicting videolaryngoscopy challenges. Participation involves data collection only, with no experimental treatments. The study runs until June 2026, with no additional follow-up specified.

Researchers are evaluating the effectiveness of apnoeic oxygenation during pediatric anesthesia to prevent low oxygen levels in children undergoing surgery. This randomized, controlled, single-blinded clinical trial focuses on infants up to 24 months and children aged 2 to 6 years. The study aims to compare oxygen levels and intubation success between children receiving apnoeic oxygenation and those who do not, addressing risks like hypoxaemia that can lead to serious complications. Participants are divided into two age groups, each with 100 children randomized equally into intervention and control groups. The intervention group receives apnoeic oxygenation via nasal cannula during anesthesia induction, supplementing standard care, while the control group undergoes standard anesthesia induction without it. This setup allows evaluation of how apnoeic oxygenation may extend safe apnea time and improve airway management. During the study, researchers will monitor the lowest oxygen saturation (SpO2) during apnea and assess intubation success, time to intubation, oxygen desaturation timing, heart rate, blood pressure changes, and anesthesia-related adverse events. These measurements occur during anesthesia induction and airway management. The total participation covers the surgical procedure period with close monitoring of respiratory and cardiovascular responses.

Researchers are evaluating a new oropharyngeal airway device designed to improve airway management during painless gastroenteroscopy. The study aims to determine if this device can reduce airway obstruction and hypoxia incidents, especially in obese and elderly patients who are more vulnerable to oxygen drops during anesthesia. This randomized, double-blind trial investigates the safety and effectiveness of this new airway compared to traditional nasal oxygen delivery methods. Participants are divided into two groups. Both groups receive oxygen at 5-6 liters per minute for about one minute before anesthesia induction, with sedatives propofol and sufentanil administered. The experimental group uses the new oropharyngeal airway connected to the endoscopic bite to deliver oxygen and monitor carbon dioxide levels, while the control group uses a nasal catheter. Propofol is continuously infused to maintain anesthesia until the procedure ends. Throughout the procedure, researchers observe the incidence of hypoxia and severe hypoxia, coughing, laryngeal spasm, and other adverse events. They also record drug dosages and endoscopist satisfaction. Monitoring includes oxygen saturation and carbon dioxide levels. The total participation includes anesthesia, endoscopy, and 30 minutes post-procedure for satisfaction assessment. The study will provide clinical experience and reference for anesthesia care in obese patients undergoing painless gastroenteroscopy.

Researchers are evaluating whether upper airway ultrasound measurements can better predict difficult airways compared to standard body measurements in adults undergoing planned surgeries requiring airway management. The study aims to improve pre-anesthetic airway assessments by comparing ultrasound parameters like tongue thickness and neck soft tissue thickness with traditional clinical predictors such as Mallampati score and neck circumference. This observational study is sponsored by Saglik Bilimleri Universitesi Gulhane Tip Fakultesi. Participants will have upper airway ultrasound and standard anthropometric measurements taken before anesthesia induction. No treatment or intervention is given, as this is a prospective observational study focusing on measurement and prediction accuracy. Ultrasound and clinical data will be collected within one hour before anesthesia to evaluate their diagnostic value for difficult mask ventilation. During the study, participants will undergo preoperative airway evaluations including ultrasound scans and standard clinical assessments. Researchers will measure the accuracy of ultrasound in predicting difficult laryngoscopy and intubation. The primary outcome is the diagnostic accuracy of ultrasound airway measurements taken shortly before anesthesia. The study will continue until December 2027 with adult patients aged 18 to 99 years undergoing elective procedures.

Researchers are studying how different ventilation parameters like mechanical power, driving pressure, and elastic power can help predict how long critically ill patients on invasive mechanical ventilation will need support. This observational study includes patients recently intubated for acute respiratory failure and aims to improve decisions about when to safely remove breathing tubes or prepare for alternatives like tracheostomy. The study monitors these ventilation values at the start of mechanical ventilation, and again at 24 and 48 hours, to see how well they predict extubation within the first week. By including all patients on invasive ventilation, the research looks beyond specific conditions like ARDS to better understand risks across a broad ICU population. Participants will be observed during their ICU stay with regular assessments of their ventilator settings and clinical condition. Researchers will track outcomes such as the timing of extubation within seven days, mortality at 28 days, development of acute kidney failure within a month, and length of ICU or hospital stay over three months. This approach aims to guide early treatment planning and improve patient management in critical care.