New Approaches to Airway Management in Tracheal Resections-A Systematic Review and Meta-analysis.

OBJECTIVES: Although endotracheal intubation, surgical crossfield intubation, and jet ventilation are standard techniques for airway management in tracheal resections, there are also reports of new approaches, ranging from regional anesthesia to extracorporeal support. The objective was to outline the entire spectrum of new airway techniques.

DESIGN: The literature databases PubMed/Medline and the Cochrane Library were searched systematically for prospective and retrospective trials as well as case reports on tracheal resections.

SETTING: No restrictions applied to hospital types or settings.

PARTICIPANTS: Adult patients undergoing surgical resections of noncongenital tracheal stenoses with end-to-end anastomoses.

INTERVENTIONS: Airway management techniques were divided into conventional and new approaches and analyzed regarding their potential risks and benefits.

MEASUREMENTS AND MAIN RESULTS: A total of 59 publications (n = 797 patients) were included. The majority of publications (71.2%) describe conventional airway techniques. Endotracheal tube placement after induction of general anesthesia and surgical crossfield intubation after incision of the trachea were used most frequently without major complications. A total of 7 new approaches were identified, including 4 different regional anesthetic techniques (25 cases), supraglottic airways (4 cases), and new forms of extracorporeal support (25 cases). Overall failure rates of new techniques were low (1.8%). Details on patient selection and procedural specifics are provided.

CONCLUSIONS: New approaches have several theoretical benefits, yet further research is required to establish criteria for patient selection and evaluate procedural safety. Given the low level of evidence, it currently is impossible to compare methods of airway management regarding outcome-related risks and benefits.