Complications Of Airway Management Research Articles

Advanced Techniques for Securing Airway in Mucopolysaccharidoses and the Impact of New Therapeutic Approaches.

Airway management in patients suffering from mucopolysaccharidoses (MPS) is one of the most difficult anesthesiologic challenges. MPS is a group of rare, inherited diseases caused by the absence or malfunctioning of lysosomal enzymes needed to break down macromolecules called glycosaminoglycans (GAGs). MPS is associated with clinical symptoms and physical features, which all together contribute to the high incidence of difficulty in providing airway during surgical procedures. We used PubMed as our main database (PubMed Advanced Search Builder) to search for relevant literature. At first, we looked for the prevalence of MPS worldwide. Then, we searched for airway management complications in the MPS population using the keywords: “Mucopolysaccharidoses,” “Anesthesia complications,” and “airway management.” Another search was carried out to look for new therapeutic agents and explore their impacts on body organs. We reviewed the finalized articles to explore how anesthesiologists used different airway techniques. We discovered that video laryngoscope and I-gel aided fiber-optic intubation have been available in recent years and have been used uneventfully in several patients. We presented recommendations regarding preoperative and intraoperative preparation to avoid airway-related complications in the future. We realized that many therapy approaches had been suggested, especially after further understanding of the pathophysiology of MPS. However, more investigation needs to be conducted to determine their efficacy and explore if there is any impact on airway management.

¿Equivale una mejor visión a una mejor intubación? Artículo original: MazzinariG, Rovira L, Henao L, Ortega J, Casasempere A, Fernandez Y. Effect of Dynamic Versus Stylet-Guided Intubation on First-Attempt Success in Difficult Airways Undergoing Glidescope Laryngoscopy: A Randomized Controlled Trial. Anesthesia-Analgesia. June 2019.Volume 128.Number 6.

El fracaso de intubación en un paciente con Vía Aérea Difícil (VAD) todavía no es infrecuente, es por ello que la amplia utilización de dispositivos de rescate de la laringoscopia directa sigue en auge. Es en este ámbito donde cobran fuerza los videolaringoscopios, que ofrecen una laringoscopia indirecta a través de un montaje multivariado de lentes y ópticas. Los videolaringoscopios nos han aportado en la especialidad de Anestesiología una visión enormemente nítida en muchos casos de glotis prácticamente imposibles, mejorando por tanto el grado de visibilidad ( clasificado en la Escala de Cormack-Lehane), pero esta ventaja no siempre conduce a un aumento en la tasa de éxito de intubación traqueal, debido a que la adecuada inserción del tubo a través de las cuerdas vocales es un factor limitante. Por ello se precisa de guías que permitan dar al tubo endotraqueal una forma adecuada para una correcta intubación. En este estudio se pretende evaluar la tasa de éxito con un videolaringoscopio usando una guía tradicional preformada con cierto ángulo de movilidad anteroposterior vs guía flexible que permite movilidad anteroposterior y lateral como es un fibrobroncospio con la fibra óptica apagada. Los resultados muestran una mejor tasa éxito en la intubación en el primer intento y menor tasa de complicaciones en el manejo de las vías respiratorias. ABSTRACT Better vision makes better intubation? The failure of intubation in a patient with Difficult Airway (VAD) is not yet uncommon, which is why the wide use of rescue devices for direct laryngoscopy is still booming. It is in this area where videolaryngoscopy gain strength, offering indirect laryngoscopy through a multivariate assembly of lenses and optics. Videolaryngoscopy have given us in Anesthesiology an enormously clear vision in many cases of practically impossible glottis, thus improving the degree of visibility (classified in the Cormack-Lehane Scale), but this advantage does not always lead to an increase in the success rate of tracheal intubation, due to the proper insertion of the tube through the vocal cords is a limiting factor. Therefore, stylet-guides are required that need to give the endotracheal tube a suitable form for proper intubation. In this study, it is expected to evaluate the success rate with a videolaryngoscope using a traditional preformed stylet-guide with a certain angle of anteroposterior mobility vs. flexible guidance that allows anteroposterior and lateral mobility such as a fiberscope with the optical fiber turned off. The results experienced a better success rate in intubation on the first attempt and a lower rate of complications in airway management with glidescope+fiberscope.

Ultrasound-guided superior laryngeal nerve block - A description of the technique

Complications in airway management remain a common cause of anesthesia-associated mortality. When a patient is considered with anticipated difficult airway, the management depends on several variables, however, at present, the standard of management continues to be the patient awake approach. In scenarios of acute upper airway obstruction, the only way to guarantee adequate ventilation is to obtain a translaryngeal or transtracheal access, for which, it is necessary to use local anesthesia and grade I / II sedation, avoiding loss of spontaneous ventilation. For this purpose, we propose ultrasound-guided superior laryngeal nerve block, in order to standardize an ultrasound landmark that is reproduceable, with a high success rate, which allows limiting complications related to regional anatomic techniques and thus facilitating the securing of the airway in these patients.

Management of airway complications following lung transplantation

Management of airway complications following lung transplantation

Bronchoscopic Interventions as a Management of Airway Complications After Lung Transplant Including Assessment of Risk Factors With Special Consideration for Pretransplant Pulmonary Hypertension

BackgroundLung transplant (LTx) is a procedure associated with risk of complications related to airway stenosis that can be treated with bronchoscopic interventions (BIs). The aim of the study was to assess the frequency and risk factors associated with increased need of bronchial interventions in the post-transplant period. MethodsThe retrospective study reviewed cases of 165 patients (63 women) who underwent LTx from April 2013 to June 2019. For dichotomous discrete variables (occurrence or lack of intervention) multivariate logistic regression analysis was performed to assess the aforementioned risk factors. ResultsBIs were required among 38.55% of lung recipients (n = 65). The number of interventions/patient/y decreases between years 1 and 2 (P < .001), 2 and 3 (P = .013), and 3 and 4 (P < .001); after the fourth year post LTx the differences are not statistically significant. Each 1 mm Hg above 25 mm Hg of mean pulmonary arterial pressure causes statistically significant elevation in the number of interventions by 0.7% in the first year after the procedure. The number of BIs per patient among lung recipients who received a transplant because of idiopathic pulmonary arterial hypertension was statistically significantly higher compared with patients with another underlying lung disease. ConclusionsAirway complications developed in the post-transplant period caused a significant number of patients to be in need of BI, especially balloon bronchoplasty. The highest number of interventions occurred within the first year after LTx, and BI decreases over time. Mean pulmonary arterial pressure measured during qualification may have the ability to predict whether the patient would require BI after LTx.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

Unplanned extubation: A costly complication of airway management that leads to preventable death

Unplanned extubation: A costly complication of airway management that leads to preventable death

Major Complications of Airway Management in Thames Valley

Major Complications of Airway Management in Thames Valley

Rescue and resuscitation factors in scuba diving and snorkeling fatalities in Australia, 2001-2013

Aim: The aim of this study was to examine first aid measures applied in a large series of Australian dive-related fatalities to better determine where improvements can be made. Methods: The National Coronial Information System was searched to identify scuba diving and snorkeling-related cases reported to various Australian Coroners for the years 2001-2013 inclusive. Coronial documents examined included witness statements, police reports and ambulance and medical reports where available. Information relating to the recovery, rescue and/or resuscitation of the victims was extracted, compiled and analyzed. Results: 126 scuba diving and 175 snorkeling-related fatalities were identified during the study period, with airway management complications reported in one-third. Cardiopulmonary resuscitation was performed in three-quarters of the incidents. An automated external defibrillator was attached to 40 victims as a first aid measure, and shocks were indicated and delivered in five cases. Although three-quarters of the reports included no information about whether supplemental oxygen was provided, it was confirmed in 19% of both the scuba diving and snorkeling incidents. Conclusion: There were often considerable delays in the recognition, rescue and/or recovery of an unconscious snorkeler or diver and, consequently, the time to commencement of basic life support. Such delays can affect chances of survival and need to be minimized. Delivery of supplemental oxygen during resuscitation appears to be relatively infrequent and sometimes suboptimal; improvement appears necessary. Some measures that would have improved availability and/or better use in these cases include the selection of appropriate equipment compatible with likely circumstances and operator skills; improved training and ongoing skills practice; and regular checking and maintenance of equipment Improved data collection and recording by official on-site investigators, preferably with knowledge of diving, would better inform potential or necessary improvements.

Is rapid sequence spinal anaesthesia a valid alternative for an emergency caesarean?

British Journal of Hospital MedicineVol. 80, No. 9 Anaesthetic and Critical Care DilemmaIs rapid sequence spinal anaesthesia a valid alternative for an emergency caesarean?Frances YoungFrances Young(E-mail Address: [email protected])Specialist Trainee in Anaesthesia, Department of Anaesthesia, Manchester University NHS Foundation Trust – Wythenshawe, Manchester M23 9LTSearch for more papers by this authorFrances YoungPublished Online:9 Sep 2019https://doi.org/10.12968/hmed.2019.80.9.554AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Afolabi BB, Lesi FEA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012 Oct 17;10:CD004350. https://doi.org/10.1002/14651858.CD004350.pub3 Medline, Google ScholarColven J, Peden C. 2012. Section 8: Obstetrics. In: Audit Recipe Book. 3rd edn. London: Royal College of Anaesthetists. Google ScholarCook T, Woodall N, Frerk C. 2011. Major complications of airway management in the United Kingdom. 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society. (accessed 14 April 2019) https://www.nationalauditprojects.org.uk/NAP4-Report Google ScholarKinsella SM, Girgirah K, Scrutton MJL. Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series. Anaesthesia. 2010 Jul;65(7):664–669. https://doi.org/10.1111/j.1365-2044.2010.06368.x Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence. 2019. Caesarean section. (accessed 14 April 2019) https://www.nice.org.uk/guidance/cg132 Google ScholarPandit JJ, Cook TM. 2014. Accidental Aawareness during General Anaesthesia in the United Kingdom and Ireland. 5th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. (accessed 15 June 2019) https://www.nationalauditprojects.org.uk/NAP5report Google ScholarRucklidge MWM, Paech MJ, Yentis SM. A comparison of the lateral, Oxford and sitting positions for performing combined spinal-epidural anaesthesia for elective Caesarean section. Anaesthesia. 2005 Jun;60(6):535–540. https://doi.org/10.1111/j.1365-2044.2005.04178.x Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 September 2019Volume 80Issue 9ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 9 September 2019 Published in print 2 September 2019 Information© MA Healthcare LimitedPDF download

The Stony Brook awake craniotomy protocol: A technical note

Most current awake craniotomy techniques utilize unnecessarily complicated airway management, and cause discomfort to the patients during the awake phase of the surgery. Our manuscript is written to discuss the neurosurgical and anesthetic techniques that we have developed to optimize awake craniotomy techniques at Stony Brook University Medical Center.We used the frameless Brainlab™ skull-mounted array for stereotactic navigation. Rigid fixation of the skull was avoided. General anesthesia with established airway was used during the “asleep” phase of the surgery. Following the removal of the bone flap and the opening of the dura, the patients were woken up, and the established airway was removed. Cortical mapping was performed to establish a safe entry zone for tumor removal. While the tumors were being removed, we continued motor examination and casual conversation with the patients to ensure safety. Patients were sedated during the remaining phase of the surgery until skin closure. No patient exhibited any neurological deficits or adverse anesthesia outcomes during the postoperative period. The protocol we developed avoids rigid skull fixation and emphasizes flexible intraoperative planning, thereby maximizing patient and physician comfort while allowing for successful tumor resection.

The impact of a checklist on the short-term complications of airway management in adults

Introduction: Airway management is an integral part of general anaesthesia, which may lead to severe short- and long-term complications. Aim: We assessed whether the application of a checklist for the steps of airway management reduces the number of complications in our institute. Method: In our observational, prospective, controlled study we made a checklist and a data collection sheet. Each airway management was performed for one month without the checklist and then for one month in the possession of the checklist. We evaluated the outcome of airway maneuvers and the occurrence of related early complications before and after the introduction of the checklist. The primary endpoint was the incidence of unexpected difficult airway. The secondary endpoints were difficult intubation, successful first intubation, aspiration, cardiac arrest, post-induction hypotension and desaturation, soft tissues/teeth injuries. Our results were also corrected for factors that affect the risk of complications (urgency of interventions, medical experience). Results: We did not find any difference in the frequency of acute complications before the introduction of the checklist (n = 439) and during the subsequent period (n = 423). At the primary endpoint (7.29% and 6.14%), there was no substantive difference (1.15%, 95% CI: -2.26%-4.56%, p = 0.5). No differences were found regarding the secondary and other endpoints. Following the correction of risk factors, there was no impact of the checklist on the incidence of complications. Conclusion: The introduction of the checklist in itself did not result in a significant change in the risk of short-term complications of airway management in our institution. Orv Hetil. 2019; 160(26): 1025-1035.

Anesthesia in patients with NBIA : Neurodegeneration with brain iron accumulation

Neurodegeneration with brain iron accumulation (NBIA) forms agroup of rare hereditary diseases with rapid neurodegenerative progression due to an abnormal accumulation of iron in the basal ganglia. This causes extrapyramidal symptoms as well as dystonia and mental retardation. The most common form of NBIA is pantothenate kinase-associated neurodegeneration (PKAN, formerly Hallervorden-Spatz syndrome). There are multiple anesthesiological challenges with great implications for the clinical routine, particularly regarding the preparation for general anesthesia and the premedication visits. As with other orphan diseases, the available recommendations are mainly based on case reports. This article gives ashort overview of complications associated with NBIA pertaining to general anesthesia. This includes anesthesia-relevant clinical symptoms and perioperative management. The published literature and case reports (available on PubMed) were reviewed to extract aset of recommendations. So far only afew reports have included the anesthesia management of NBIA patients. Most of them refer to PKAN as the predominant type (50% of cases). Recommendations were found on www.orphananesthesia.eu and consensus guidelines on PKAN in general. In particular, dystonia-related restrictions in the maxillofacial area can complicate airway management and cause difficulties with respect to intubation. Furthermore, local or regional anesthesia as the sole anesthesia technique is not eligible/viable due to the reduced compliance of the patient. Special attention should be paid to atimely premedication visit and evaluation to ensure sufficient time to safely plan and prepare the anesthetic procedure. The handling of NBIA patients requires good preparation, including an interdisciplinary team and customized time management. In principle, both general anesthesia as abalanced method and total intravenous anesthesia (TIVA) seem to be possible/viable options. The main focus is on airway management. Even after brief sedation in the context of diagnostic measures, the patient should be monitored for longer than usual.

Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey.

In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a 'Never Event' in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre-intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was 'available' in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and 'always available' in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new 'Never Event' and has the potential to improve airway management.

Application of surgical cricothyrotomy in emergency and complicated airway management

Objective:To explore the feasibility of intercricothyrotomy in emergency airway management. Method:Characteristics of 27 cases underwent surgical cricothyrotomy were analyzed. Result:The main causes of emergency were severe trauma of head and neck, larynx stenosis, interspaces infection of the floor of the mouth and submaxillary space, etc; all the patients were divided into 2 groups : surgical cricothyrotomy as the first choice (group A,16/27) and surgical cricothyrotomy after conventional tracheotomy (group B,11/27); The average time of opening airway for group A was much shorter than group B ［(58.12±24.41)s, (739.09±245.29)s,respectively, P<0.01)］; Bleeding in group A (14 cases) was much less than group B (13 cases) ［(2.36±1.16)ml, (4.65±4.31)ml,respectively, P<0.01］; Except 1 cases died from primary disease, 4 cases with laryngeal stenosis underwent laryngeal dilation with T type expansion tube and 2 cases of bilateral recurrent laryngeal nerve palsy, the average time with tracheal tube of the remaining 20 patients was (12.35±7.29)d, no postoperative complications such as larynx or tracheal stenosis were found. All of them were successfully extubation. Conclusion:Surgical cricothyrotomy procedure is fast and safe with simple and convenient that can be used as the preferred method of rapid airway opening when a critical respiratory tract was difficult to manage.

Analysis of adverse outcomes in the post-anesthesia care unit based on anesthesia liability data

Study objectiveThe aim of this study is to provide a contemporary medicolegal analysis of claims brought against anesthesiologists in the United States for events occurring in the post-anesthesia care unit (PACU). DesignIn this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database. SettingClaims closed between January 1, 2010 and December 31, 2014 were included for analysis if the alleged damaging event occurred in a PACU and anesthesiology was named as the primary responsible service. PatientsForty-three claims were included for analysis. Data regarding ASA physical status and comorbidities were obtained, whenever available. Ages ranged from 18 to 94. Patients underwent a variety of surgical procedures. Severity of adverse outcomes ranged from temporary minor impairment to death. InterventionsPatients receiving care in the PACU. MeasurementsInformation gathered for this study includes patient demographic data, alleged injury type and severity, operating surgical specialty, contributing factors to the alleged damaging event, and case outcome. Some of these data were drawn directly from coded variables in the CRICO CBS database, and some were gathered by the authors from narrative case summaries. ResultsSettlement payments were made in 48.8% of claims. A greater proportion of claims involving death resulted in payment compared to cases involving other types of injury (69% vs 37%, p = 0.04). Respiratory injuries (32.6% of cases), nerve injuries (16.3%), and airway injuries (11.6%) were common. Missed or delayed diagnoses in the PACU were cited as contributing factors in 56.3% of cases resulting in the death of a patient. Of all claims in this series, 48.8% involved orthopedic surgery. ConclusionsThe immediate post-operative period entails significant risk for serious complications, particularly respiratory injury and complications of airway management. Appropriate monitoring of patients by responsible providers in the PACU is crucial to timely diagnosis of potentially severe complications, as missed and delayed diagnoses were a factor in a number of the cases reviewed.

Emergency airway management in the critically ill: a 1 yr review of practice within a London teaching hospital

Emergency airway management in the critically ill is complex and potentially hazardous.1 The Difficult Airway Society (DAS) is developing a critical care intubation guideline.2 Our aims were to examine local practice in relation to intubations performed in the critically ill outside of the operating theatre, and to identify ways to improve care. All critical care intubations from February 2016 to 2017 were reviewed retrospectively. Patients were identified from the electronic patient database (AcuBase) and data analysed from medical records. Patients were excluded if intubated in theatre for emergency surgery, not admitted to the intensive care unit (ICU), and had a tracheostomy in situ. The project was registered with the trust governance team. Ninety intubation events were identified, with 16 (18%) defined as difficult (more than two attempts/more than 10 min to intubate/other features defined as difficult by a senior anaesthetist). Table 2 demonstrates our key results.Table 2Characteristics of intubation events. DA, Difficult Airway; ICU, Intensive Care Unit; ED, Emergency Department; HFNC, High Flow Nasal Cannula.Intubation events (n=90)Senior operator, n (%)Consultant, 27 (30)ST5+, 30 (33)ST3-4, 27 (30)Not recorded, 7 (7)Difficult airway (DA) cohort5 (31)6 (38)5 (31)0 (0)Location, n (%)ICU, 47 (52)ED, 21 (23)Ward, 16 (18)Theatre, 6 (7)DA cohort8 (50)5 (31)2 (13)1 (6)Preoxygenation, n (%)Waters, 35 (39)BiPAP, 5 (6)HFNC, 4 (4)Not recorded, 46 (51)DA cohort7 (44)1 (6)1 (6)7 (44)Positioning, n (%)Sitting, 7 (8)20–40 deg, 4 (4)Oxford pillow, 1 (1)Not recorded, 78 (87)DA cohort1 (6)1 (6)1 (6)13 (81)ApOx, n (%)Yes, 5 (6)No, 2 (2)Not recorded, 83 (92)DA cohort1 (6)0 (0)15 (94)Bagged electively, n (%)Yes, 11 (12)No, 1 (1)Not recorded, 78 (87)DA cohort6 (36)0 (0)10 (64)Airway operators, n (%)Two, 51 (57)One, 32 (36)Not recorded, 7 (7)DA cohort9 (56)7 (44)0 (0)First laryngoscopic attempt, n (%)DL, 50 (55)VL, 17 (19)Not recorded, 23 (26)DA cohort7 (44)6 (38)3 (18) Open table in a new tab Only 57% of intubations were performed with two airway operators, and the senior operator was often relatively junior (consultant, 30%). The use of nasal oxygenation to prolong time to desaturation was only used in 6%, suggesting a lack of familiarity. In the difficult airway group, a video laryngoscope was used for the first intubation attempt in 38% patients, likely reflecting changing practice amongst anaesthetists. There were an equal number of cases (two vs two) where video and direct laryngoscopy rescued each other after failure with the first technique; hence, competence in both is essential. The documentation of airway interventions was poor and sometimes not performed. Grade of intubation was often recorded, but lacked context (e.g. positioning). After these results, we have developed a local intubation checklist, which addresses human factors and multidisciplinary team working, and acting as a standardised form for documenting airway interventions outside of theatre. It is being tested within our in situ simulation programme before its launch in late 2017. This checklist complements our system of highlighting ICU patients with difficult airways (identified from theatre or outwith) with a bedside warning, documented airway management plan, and discussion at operational handover. All of these have been well received by the multidisciplinary team and aim to complement future DAS guidelines for critical care. 1.Cook TM, Woodall N, Frerk C. On behalf of the Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011; 106: 632–422.Higgs A, et al. Br J Anaesth 2016; 117: i5–9

Mechanical complications and outcomes following invasive emergency procedures in severely injured trauma patients

This study aimes to determine the complication rates, possible risk factors and outcomes of emergency procedures performed during resuscitation of severely injured patients. The medical records of patients with an injury severity score (ISS) >15 admitted to the University Hospital Leipzig from 2010 to 2015 were reviewed. Within the first 24 hours of treatment, 526 patients had an overall mechanical complication rate of 26.2%. Multivariate analysis revealed out-of-hospital airway management (OR 3.140; 95% CI 1.963–5.023; p < 0.001) and ISS (per ISS point: OR 1.024; 95% CI 1.003–1.045; p = 0.027) as independent predictors of any mechanical complications. Airway management complications (13.2%) and central venous catheter complications (11.4%) were associated with ISS >32.5 (p < 0.001) and ISS >33.5 (p = 0.005), respectively. Chest tube complications (15.8%) were associated with out-of-hospital insertion (p = 0.002) and out-of-hospital tracheal intubation (p = 0.033). Arterial line complications (9.4%) were associated with admission serum lactate >4.95 mmol/L (p = 0.001) and base excess <−4.05 mmol/L (p = 0.008). In multivariate analysis, complications were associated with an increased length of stay in the intensive care unit (p = 0.019) but not with 24 hour mortality (p = 0.930). Increasing injury severity may contribute to higher complexity of the individual emergency treatment and is thus associated with higher mechanical complication rates providing potential for further harm.

Herpes simplex laryngitis presenting as airway obstruction in a stroke patient.

We present the second confirmed report of HSV laryngitis in an adult stroke patient, resulting in complicated airway management issues. This rare presentation of laryngeal HSV in a stroke patient can interfere with speech, language, and swallowing functions and confounds the etiology of these issues, which can impact subsequent management.

Strategies for the prevention of airway complications - a narrative review.

Despite being infrequent, complications of airway management remain an important contributor to morbidity and mortality during anaesthesia and care of the critically ill. Developments in the last three decades have made anaesthesia safer, and this has been mirrored in the equipment and techniques available for airway management. Modern technology including novel oxygenation modalities, widespread availability of capnography, second-generation supraglottic airway devices and videolaryngoscopy provide the tools to make airway management safer still. However, technology will only take safety so far, and non-technical aspects of airway management are critically important for communication and decision making during airway crises, acknowledging a 'cannot intubate, cannot oxygenate' situation and transitioning to emergency front of neck airway. Randomised controlled trials provide little useful information about safety in this setting, and data from registries and databases are likely to be of more value. This narrative review focuses on recent evidence in this area.