effectiveness of PICES model practice guideline for prevention of tracheal injury in patient undergo general anesthesia with endotracheal intubation in Nakhon Phanom hospital.

Abstract

Abstract 

     Objectives: The main purpose was to compare the effectiveness of the perioperative guideline for tracheal injury prevention in patient undergoing general anesthesia before and after the PICES model guideline was implemented, and to measure the average of satisfaction level with the overall implementation of the guideline.

   Materials and method: This study was a Quasi-experimental research implemented  between October 2024 and April 2025 in operating theatre at Nakhon Phanom hospital.The patient’s undergoing general anesthesia was included overall 160 cases. Comparing the effectiveness of the PICES model practice guideline of tracheal injury prevention in patient’s undergoing general anesthesia with endotracheal intubation. After consent was given ,the patients were taken in the PICES model process that divided into two groups. Each group of the groups were before the PICES model guideline from retro-medical records in October 2023 to September 2024 for 62 cases and after the PICES model guideline from October 2024 to April 2025 for 62 cases, and 21 anesthetic nurses staff. The study tool included the PICES model guideline for tracheal injury prevention in patient undergoing general anesthesia .The content validity was examined by 3 experts, yielding a number of 1. The Data were collected by using 1)retro-medical record checklist 2) case record form 3) anesthetic record and 4) satisfaction of anesthetic nurses staff form. The content validity was examined by 3 experts and the reliability for satisfaction were 0.90 ,0.95 and 0.97 respectively. Statistical analyses were performed using Chi square, t-tests, Fisher’s exact ,and multivariable logistic regression at statistical significant level 0.05. Results: The incident of tracheal injury in patient undergoing general anesthesia before and after guideline had presented the statistically significant difference of postoperative sore throat in recovery room and post-operative within 24 hour at P-value<0.001 and P-value<0.001 respectively. Otherwise, there were no statistically significant difference of the post-operative hoarseness within 24 hour between before and after guideline. The average sore throat pain score was lower in after guideline group at p-value <0.001.In addition, after adjusted the nuisances factor using the multivariable logistic regression presented the intra endotracheal cuff pressure in before guideline was increasing the incident of tracheal injury in patient undergoing general anesthesia than  after guideline 6.7 fold with p-value = 0.002 and the higher intubation attempt > 2 time in before guideline group had a higher risk of tracheal injury in patient undergoing general anesthesia than after guideline group 11.33 fold with p-value p-value = 0.006.Satisfaction with the overall implementation of the PICES model guideline, the average satisfaction level was high( =3.87).

Conclusion: The effectiveness of PICES model practice guideline of tracheal injury prevention in patient’s undergoing general anesthesia , including Proven  airway injury,  Intubation management, cuff pressure management, Extubation Management, and Shift Records can decline of the incident of tracheal injury in patient’s undergoing general anesthesia. 

Keywords: Endotracheal tube cuff pressure, Clinical nursing practice guideline of perioperative tracheal injury prevention, Endotracheal tube cuff pressure monitoring, general anesthesia.