title: Difficult airway management resources and capnography use in Japanese intensive care units: a nationwide cross-sectional study.
abstract: The availability of difficult airway management (DAM) resources and the extent of capnometry use in Japanese intensive care units (ICUs) remained unclear. The purpose of this study was to clarify whether: (1) DAM resources were adequate, and (2) capnometry was routinely applied in Japanese ICUs.
  
  
  
  This nationwide cross-sectional study was conducted from September 2015 to February 2016. All ICUs received a mailed questionnaire about their DAM resources and use of capnometry. Outcome measures were availability of: (1) 24-h in-house backup coverage; (2) a supraglottic airway device (SGA); (3) a dedicated DAM cart; and (4) surgical airway devices, and (5) routine use of capnometry to verify tube placement and for continuous monitoring of ventilator-dependent patients. The association between these outcomes and ICU type (academic, high-volume, closed, surgical) was also analyzed.
  
  
  
  Of the 289 ICUs, 196 (67.8 %) returned completed questionnaires. In-house backup coverage and surgical airway devices were highly available (89.3 and 95.9 %), but SGAs and dedicated DAM carts were not (60.2 and 60.7 %). The routine use of capnometry to confirm tube placement was reported by 55.6 % of the ICUs and was highest in closed ICUs (67.2 %, p = 0.03). The rate of continuous capnography monitoring was also 55.6 % and was highest in academic ICUs (64.5 %, p = 0.04).
  
  
  
  In Japanese ICUs, SGAs and dedicated DAM carts were less available, and capnometry was not universally applied either to confirm tube placement, or for continuous monitoring of ventilated patients. Our study revealed areas in need of improvement.
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. windmill@fmu.ac.jp.|Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan. windmill@fmu.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Fukushima Medical University, Fukushima, Japan.|Fukushima Global Medical Science Center, Fukushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanigawa
authors.affiliation: Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shinohara
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Yano
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Sorimachi
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Lubna
authors.initials: L
authors.lastname: Sato
authors.affiliation: Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Inokuchi
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Shimada
authors.affiliation: Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Choichiro
authors.initials: C
authors.lastname: Tase
mesh_terms: D058109:Airway Management / Q000379:methods*; D019296:Capnography; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D008991:Monitoring, Physiologic; D011795:Surveys and Questionnaires
keywords: Airway equipment; Capnometry; Portable storage unit; Postal survey; Supraglottic airway device