Orsillo, S. M. (2001). Measures for acute stress disorder and posttraumatic stress disorder. In M.M. Antony & S.M. Orsillo (Eds.), Practitioner's guide to empirically based measures of anxiety (pp. 255-307). Kluwer Academic/Plenum. PTSDpubs ID 24368
tk a developer's guide pdf 31
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This measure was developed by staff at VA's National Center for PTSD and is in the public domain and not copyrighted. In accordance with the American Psychological Association's ethical guidelines, this instrument is intended for use by qualified health professionals and researchers.
If the authors provide incomplete or confusing information about their ICC form, its correctness becomes questionable, and the ICC value must be interpreted with caution. Conversely, if the authors provide complete information about their ICC form, readers may then use Fig 1 as a guideline to evaluate the correctness of the ICC form used in the analysis. If so, the 95% confident interval of the ICC estimate (not the ICC estimate itself) should be used as the basis to evaluate the level of reliability using the following general guideline:
Practice guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care. These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies. In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome. Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice. They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.
For these practice guidelines, a difficult airway includes the clinical situation in which anticipated or unanticipated difficulty or failure is experienced by a physician trained in anesthesia care, including but not limited to one or more of the following: facemask ventilation, laryngoscopy, ventilation using a supraglottic airway, tracheal intubation, extubation, or invasive airway. These clinical situations are further defined as follows.
The purposes of these guidelines are to guide the management of patients with difficult airways, optimize first attempt success of airway management, improve patient safety during airway management, and minimize/avoid adverse events. The principal adverse outcomes associated with the difficult airway include (but are not limited to) death, brain injury, cardiopulmonary arrest, airway trauma, and damage to the teeth. The appropriate choice of medications and techniques for anesthesia care and airway management is dependent upon the experience, training, and preference of the individual practitioner, requirements or constraints imposed by associated medical issues of the patient, type of procedure, and environment in which airway management takes place. The choice of agents, techniques, and devices may be limited by federal, state, or municipal regulations or statutes.
These guidelines do not address education, training, or certification requirements for practitioners who provide anesthesia and airway management. Some aspects of the guidelines may be relevant in other clinical contexts. The guidelines do not represent an exhaustive consideration of all manifestations of the difficult airway or all possible approaches to airway management.
These guidelines are intended for use by anesthesiologists and all other individuals who perform anesthesia care or airway management. The guidelines are intended to apply to all airway management and anesthetic care delivered in inpatient (e.g., perioperative, nonoperating room, emergency department, and critical care settings) and ambulatory settings (e.g., ambulatory surgery centers and office-based surgery and procedure centers performing invasive airway procedures). Excluded are prehospital settings and individuals who do not deliver anesthetic care or perform airway management. These guidelines are also intended to serve as a resource for other physicians and patient care personnel who are involved in the care of difficult airway patients, including those involved in local policy development.
In 2019, the ASA Committee on Standards and Practice Parameters requested that these guidelines be updated. This update is a revision developed by an ASA-appointed task force of 15 members, including physician anesthesiologists in both private and academic practices from the United States, India, Ireland, Italy, and Switzerland; an independent consulting methodologist; and an ASA staff methodologist. Conflict-of-interest documentation regarding current or potential financial and other interests pertinent to the practice guideline were disclosed by all task force members and managed.
Examples of combination techniques include: (1) direct or video laryngoscopy combined with either optical/video stylet, flexible intubation scope, airway exchange catheter, retrograde-placed guide wire, or supraglottic airway placement and (2) supraglottic airway combined with either optical/video stylet or flexible intubation scope (with or without hollow guide catheter). A randomized controlled trial comparing a lightwand combined with direct laryngoscopy versus a lightwand alone for intubation reported equivocal findings for successful intubation, first attempt success, time to intubation, and number of intubation attempts (Category A3-E evidence).438 A randomized controlled trial comparing a videolaryngoscope combined with a flexible bronchoscope reported a greater first attempt success rate with the combination technique than with a videolaryngoscope alone (Category A3-B evidence).439
An extubation strategy includes interventions that may be used to facilitate airway management associated with extubation of a difficult airway. Extubation intervention topics addressed by these guidelines include: (1) assessment of patient readiness for extubation, (2) the presence of a skilled individual to assist with extubation, (3) selection of an appropriate time and location for extubation, (4) planning for possible reintubation, (5) elective tracheostomy, (6) awake extubation or supraglottic airway removal, (7) supplemental oxygen throughout the extubation process, and (8) extubation with an airway exchange catheter or supraglottic airway. The task force regards the concept of an extubation strategy as a logical extension of the intubation strategy.
The consultants and members of participating organizations strongly agree with recommendations to have a preformulated strategy for extubation and subsequent airway management, ensure that a skilled individual is present to assist with extubation, and select an appropriate time and location for extubation when possible. The consultants strongly agree and members of participating organizations agree or strongly agree with recommendations to assess the relative clinical merits and feasibility of the short-term use of an airway exchange catheter and/or supraglottic airway that can serve as a guide for expedited reintubation and evaluate the risks and benefits of elective surgical tracheostomy before attempting extubation. The consultants and members of participating organizations strongly agree with recommendations to evaluate the risks and benefits of awake extubation versus extubation before the return to consciousness and assess the clinical factors that may produce an adverse impact on ventilation after the patient has been extubated.
The consultants and members of participating organizations strongly agree with the recommendation to inform the patient (or responsible person) of the airway difficulty that was encountered to provide the patient (or responsible person) with information to guide and facilitate the delivery of future care and to document the presence and nature of the airway difficulty in the medical record to guide and facilitate the delivery of future care.
For the systematic review, potentially relevant clinical studies were identified via electronic and manual searches. Bibliographic database searches included PubMed and EMBASE. The searches covered a 9.25-yr period from January 1, 2012, through March 31, 2021. Citation searching (backward and forward) of relevant meta-analyses and other systematic reviews was also performed. No search for gray literature was conducted. Publications identified by task force members were also considered. Accepted studies from the previous guidelines were re-reviewed, covering the period of January 1, 2002, through June 31, 2012. Only studies containing original findings from peer-reviewed journals were acceptable. Editorials, letters, and other articles without data were excluded. A literature search strategy and PRISMA* flow diagram are available as Supplemental Digital Content 2, In total, 12,544 unique new citations were identified, with 1,026 full articles assessed for eligibility. After review, 619 were excluded, with 407 new studies meeting inclusion criteria. These studies were combined with 190 pre-2012 articles from the previous guidelines, resulting in a total of 597 articles accepted as evidence for these guidelines. In this document, 559 are referenced, with a complete bibliography of articles used to develop these guidelines, organized by section, available as Supplemental Digital Content 3,
Each pertinent outcome reported in a study was classified by evidence category and level and designated as beneficial, harmful, or equivocal. Findings were then summarized for each evidence linkage and reported in the text of the updated guidelines.
The literature contains multiple randomized controlled trials, but the number of randomized controlled trials is not sufficient to conduct a viable meta-analysis for the purpose of these guidelines. Findings from these randomized controlled trials are reported separately as evidence. 2ff7e9595c
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