读图|临床环境、医生的技能、可用资源和病人的合作程度应该在困难气道处理中得到重视

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Decision Making in the Dificult Airnway Algorithm 

困难气道指南的决策

What are the latest updates to the difficult airway algorithm?

困难气道指南的最新更新是什么？

The ASA Task Force on Management of the Difficult Airway has developed a decision tree tool to guide the anesthesiologist's choice of pathway in the ASA's difficult airway algorithm.

ASA困难气道管理工作组开发了一个决策树工具，以指导麻醉医生在ASA困难气道指南中选择合适路径。

In addition to important clinical risk assessments such as the predicted ease of intubation and ventilation, the tool considers other contextual influences such as the clinician's skill, available resources, and level of patient cooperation.

除了重要的临床风险评估，如预测插管和通气的难易程度外，该工具还考虑了其他背景影响因素，如临床医生的技能、可用资源和病人的合作程度。

Anesthesiologists are quite familiar with the American Society of Anesthesiologists (ASA)  Difficult Airway Algorithm (DAA). Developed in the 1990s, this algorithm classically separated  the management of tracheal intubation into the awake pathway and after induction of general  anesthesia. It has undergone several revisions since as advances in techniques and equipment  entered the clinician’s arsenal over time. 

麻醉医生对美国麻醉医师协会（ASA）困难气道指南（DAA）相当熟悉。该指南制定于20世纪90年代，经典地将气管插管的管理分为清醒路径和全麻诱导后。此后，随着技术和设备的进步，它经历了几次修订，成为临床医生的武器库。

What was missing from the DAA were key elements of  decision making that would guide the anesthesia care provider through the pathway. The ASA  Task Force on Management of the Difficult Airway recently convened to address these gaps. The  result is the 2022 update to the DAA which provides a decision tree tool consisting of critical  questions to be asked by anesthesiologists during airway management. 

DAA中缺少的是指导麻醉护理人员完成整个路径的决策的关键因素。ASA困难气道管理特别小组最近召开会议，以解决这些问题。其结果是2022年对DAA进行了更新，提供了一个决策树工具，其中包括麻醉医生在气道管理中应提出的关键问题。

These include addressing whether or not the patient will be predictably challenging to intubate and/or noninvasively  ventilate, whether they pose a significant aspiration risk, and their tolerance of apneic time.  Additionally, the task force incorporated the unique variables that may have significant impact  on airway management. 

这些问题包括解决患者插管和/或无创通气方面是否具有可预见性的挑战，是否会造成严重的误吸风险，以及他们对呼吸暂停时间的耐受性。 此外，工作组还纳入了可能对气道管理产生重大影响的独特变量。

The clinician’s experience and skill set, the patient’s unique clinical  context and level of cooperation, and available resources are all emphasized as seen in this  infographic. The reader is encouraged to review the cited article for a full scope of understanding  of these concepts.