Pulmonology
Airway management
Airway management is a fundamental skill in critical care, essential for ensuring adequate oxygenation and ventilation in critically ill patients. Tracheal intubation, difficult airway management, and the prevention of complications require a structured, evidence-based approach to improve patient safety and outcomes.
This section covers key aspects of airway management, including:
- Tracheal intubation in critically ill patients, with guidelines on best practices to reduce complications and improve procedural success.
- Difficult airway management, outlining strategies for handling unanticipated challenges, including the use of alternative airway devices and emergency front-of-neck access.
- Preventing unrecognized oesophageal intubation, a crucial step in avoiding catastrophic outcomes by utilizing waveform capnography and structured confirmation techniques.
- Awake tracheal intubation, a recommended strategy for anticipated difficult airways, enhancing patient safety and intubation success rates.
By integrating clinical guidelines, expert recommendations, and advanced airway management techniques, this section provides healthcare professionals with the tools to enhance patient safety, procedural efficiency, and airway management outcomes in critical care settings.
Tracheal intubation in the critically ill
Tracheal intubation
Guidelines for the management of tracheal intubation in critically ill adults
A. Higgs et al., British Journal of Anesthesia (2018)
What’s inside
This article provides guidelines for managing tracheal intubation in critically ill adults, covering techniques, team preparation, and equipment optimization. It addresses the unique challenges of airway management in intensive care and emergency settings.
Why it’s relevant
The recommendations are vital for clinicians handling high-risk intubations in ICUs and EDs, aiming to reduce complications and improve patient safety.
Key focus
- Challenges in airway management for critically ill patients.
- Techniques to ensure effective oxygenation and minimize complications.
- Importance of team preparation, training, and standardized equipment.
- Special considerations for trauma and other complex cases.
Takeaway
- Implement standardized protocols and use cognitive aids for intubation.
- Prioritize training to improve technical and non-technical skills.
- Optimize equipment and team coordination to enhance outcomes.
Tracheal intubation outside the OR
Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies
Kunal Karamchandani et al., Anesthesia & Analgesia (2021)
What’s inside
A comprehensive review of emergency airway management outside the operating room (OR), focusing on challenges in non-OR settings like ICUs and hospital wards.
Why it’s relevant
Airway management in non-OR settings has a higher risk of complications, including cardiopulmonary issues, which can critically affect patient outcomes.
Key focus
- Strategies for managing difficult airways (anatomic, physiologic, situational).
- Preparation, oxygenation techniques, and medication selection.
- Post-intubation complications and their impact on outcomes.
Takeaway
Effective non-OR airway management requires expertise, thorough preparation, and vigilant monitoring to reduce complications and improve patient safety.
The difficult airway
Difficult airway
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults
C. Frerk et al., British Journal of Anaesthesia (2015)
What’s inside
A comprehensive set of guidelines from the Difficult Airway Society (DAS) addressing the management of unanticipated difficult intubation in adults, emphasizing strategies to enhance patient safety during airway emergencies.
Why it’s relevant
Unanticipated difficult intubations can lead to severe complications. These guidelines provide evidence-based recommendations to improve outcomes and standardize care in such critical situations.
Key focus
- Preparation and planning, including pre-induction assessments and contingency plans.
- Airway management algorithms with step-by-step approaches for failed intubation scenarios.
- Techniques and equipment, such as videolaryngoscopy, supraglottic airway devices, and emergency front-of-neck access.
- Human factors, emphasizing communication, teamwork, and decision-making during airway crises.
Takeaway
Adherence to the DAS 2015 guidelines provides clear, structured approaches to managing unexpected difficult intubations, reducing the risk of adverse outcomes and improving patient safety.
Preventing unrecognised oesophageal intubation
Preventing unrecognised oesophageal intubation
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies
N. Chrimes et al., Anaesthesia (2022)
What’s inside
A consensus guideline from the Project for Universal Management of Airways (PUMA) and international airway societies, focusing on preventing unrecognized oesophageal intubation during airway management.
Why it’s relevant
Unrecognized oesophageal intubation can lead to severe hypoxaemia, brain injury, and death. This guideline provides strategies to reduce such preventable incidents across various clinical settings.
Key focus
- Emphasis on using waveform capnography to detect sustained exhaled carbon dioxide as the primary method to confirm tracheal intubation.
- Recommendations for immediate tube removal if sustained exhaled carbon dioxide is not detected, unless deemed dangerous.
- Alternative techniques for confirming tube placement when capnography is inconclusive.
- Addressing human factors, such as cognitive biases and team performance, during airway emergencies.
Takeaway
Implementing these guidelines can enhance patient safety by ensuring prompt recognition and correction of oesophageal intubation, thereby reducing the risk of severe complications.
Awake tracheal intubation
Awake tracheal intubation
Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults
I. Ahmad et al., Anaesthesia (2020)
What’s inside
The Difficult Airway Society (DAS) provides comprehensive guidelines for awake tracheal intubation (ATI) in adults, offering strategies to enhance patient safety during anticipated difficult airway management.
Why it’s relevant
Awake tracheal intubation has a high success rate and a favorable safety profile but is underused in cases of anticipated difficult airway management.
Key focus
- Indications for ATI, including criteria for patients with predicted difficult airways.
- Preparation guidance, such as procedural checklists and equipment readiness.
- Techniques for oxygenation, airway topicalization, sedation, and tracheal tube position verification.
- Management strategies for unsuccessful ATI attempts and post-intubation care.
- Training recommendations, emphasizing practitioner competence and informed patient consent.
Takeaway
Implementing these guidelines can improve patient safety by providing structured approaches to awake tracheal intubation, reducing risks in difficult airway management.