title: Procedural difficulties during successful intubation in octogenarians: A prospective observational study.
abstract: OBJECTIVE
  Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks.
  
  
  METHODS
  An institutional review board-approved difficult airway prospective observational study in older adults was conducted. Inclusion criteria included airway features indicative of difficult airway, history of failed intubation, the planned use of specialized airway devices, and/or expected airway complications due to comorbidities. Patients 80 years and older were analyzed. Demographic data collected were age, weight, BMI, gender, ASA classification, airway indices, diagnosis, and procedures. Problems with intubation (INT) (≥3 intubation attempts), laborious assisted ventilation (VEN) (2-person and/or application of CPAP>20cmH2O), and complications with oxygenation (OXY) (SpO2<95%) were analyzed.
  
  
  RESULTS
  Of the 41 patients enrolled in the study, 3 (7.3%) had all 3: problematic (INT), laborious (VEN), and desaturated (OXY); 8 (19.5%) patients experienced problematic (INT), 20 (48.8%) were described as laborious (VEN), and 14 (34.1%) experienced complications with (OXY).
  
  
  CONCLUSIONS
  In octogenarians, we found a low incidence of difficulty with INT-VEN-OXY together. However, bag mask ventilation was found to be laborious with a high incidence of desaturation. Success rate of INT as a sole metric may not accurately describe the process of the intubation. We recommend alternative airway devices and techniques and the establishment of protocols for airway management in the elderly.
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Estados Unidos. Electronic address: ybryan@wakehealth.edu.
authors.forename: Y F
authors.initials: YF
authors.lastname: Bryan
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Estados Unidos.
authors.forename: K N
authors.initials: KN
authors.lastname: Johnson
mesh_terms: D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D012720:Severity of Illness Index
chemical_list: D010100:Oxygen
keywords: Elderly; Intubación; Intubation; Octogenarians; Octogenarios; Oxigenación; Oxygenation; Personas mayores; Procedimiento; Process; Ventilación; Ventilation