Construction Of An Evidence-based Preoperative Airway Management Program For Cardiac Surgery With Cardiopulmonary Bypass

Objectives: Based on the best evidence of preoperative airway management for cardiac surgery with cardiopulmonary bypass(CPB),to construct a localized preoperative airway management program for CPB cardiac surgery,and initially verify the feasibility and effectiveness of this program.Methods: According to the “6S Model of Evidence Resource”,this study searched the literature related to preoperative airway management for cardiopulmonary bypass cardiac surgery at home and abroad layer-by-layer,evaluated the quality of the included literature,summarized and graded the extracted evidence,and formed the best evidence summary of preoperative airway management for CPB cardiac surgery.Then,based on the content of the best evidence summary and guided by the concept of prerehabilitation,the first draft of the protocol was constructed,and the overall structure,specific content,and expression of the first draft of the protocol were modified and improved by Delphi expert consultation method to form the final program for preoperative airway management for cardiac surgery with cardiopulmonary bypass.Finally,a quasiexperimental study design was used.72 eligible patients from the cardiac surgery department in a Grade 3A hospital in Sichuan Province were selected for the pilot trial.The patients were included from August 2022 to September 2022 as the control group who received routine care,the patients were enrolled from October 2022 to November2022 as the intervention group receiving the evidence-based preoperative airway management program.The incidence of postoperative pulmonary complications,the length of stay in ICU,the length of mechanical ventilation and ICU readmission rate were compared between the two groups.Results: 1.In the evidence summary part,23 articles were finally included,including 3 clinical decisions,2 guidelines,4 evidence summaries,4 expert consensus,10 meta-analysis and systematic reviews,forming 7 categories and 31 pieces of evidence were formed,and the first draft of preoperative airway management pragram for cardiopulmonary bypass cardiac surgery was constructed.2.In the two rounds of Delphi expert consultation,the questionnaire recall rate was 100%,the authority coefficient of the experts was 0.9,and the Kendall’s W value of the items was 0.32 and 0.36,respectively(p<0.05).According to the expert opinions,2 items were deleted,10 items were modified,and 5 new items were added to form the final program of preoperative airway management for cardiopulmonary bypass cardiac surgery.The final program includes 5 level I items,12 level II items,and 28 level III items.3.67 patients were included in the pilot trial,including 33 patients in the control group and 34 patients in the intervention group.The patient retention rate was 93.1%.The results showed that there was no significant difference between the two groups in the incidence of postoperative pulmonary infection and pleural effusion,the length of ICU stay and duration of mechanical ventilation(p>0.05),but the incidence of atelectasis was significantly decreased in the intervention group(p=0.023),and none of the patients in both groups had respiratory failure and re-admission to the ICU.Conclusion: This study is based on the evidence-based and Delphi expert consultation method to construct a preoperative airway management program for cardiac surgery with cardiopulmonary bypass,which is necessary,scientific and clinically applicable.The program was proven to be highly feasible and can significantly reduce the incidence of postoperative pulmonary atelectasis.