Role In Airway Management Research Articles

Airway management for endoscopic treatment of laryngotracheal stenosis

ObjectivesTo describe the airway management techniques used during endoscopic management of laryngotracheal stenosis (LTS), and to identify patient, surgical, and clinician factors that are associated with use of jet ventilation, transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), and intermittent apnea, including primary technique success vs failure and complications. MethodsRetrospective review of electronic medical records was performed for all patients undergoing direct laryngoscopy for LTS over a seven-year period. Patients with an existing tracheostoma at the time of surgery were excluded. Univariate chi-squared analyses were performed to identify patterns in airway management based on patient and surgical factors. ResultsA total of 92 endoscopic surgeries for 41 unique patients were identified. Airway management techniques differed based on the procedure performed (P < 0.001). Jet ventilation and THRIVE were particularly associated with subglottic procedures, and transtracheal jet ventilation with supraglottic procedures. There were no differences in complication rate based on airway management technique. The rate of primary airway plan failure was 50 % for THRIVE, 15 % for jet ventilation, 2 % for intermittent apnea, and 0 % for endotracheal intubation (p = 0.002). The presence of an anesthesiologist specializing in head and neck anesthesia was associated with significantly greater rates of jet ventilation and THRIVE (41 % vs 7 % for jet ventilation, 9 % vs 4 % for THRIVE; p = 0.002). ConclusionPatient and surgical factors play an important role in airway management planning for patients undergoing endoscopic laryngotracheal procedures. The presence of a head and neck anesthesiologist was associated with a more diverse array of airway management options for these patients.

Video Laryngoscope-Guided Fiberoptic Intubation in Patients with Unanticipated Difficult Airway: Two Case Reports

Fiberoptic intubation plays a crucial role in airway management. In particular, it is considered a basic method in difficult airway management. To enhance the success rate and feasibility of fiberoptic intubation, various adjunctive methods are often used concurrently. Video laryngoscope can be a valuable adjunct during fiberoptic intubation by ensuring visualization of laryngeal space and facilitating real-time monitoring of fiberoptic bronchoscope movements. In this report, we present our experiences with video laryngoscopy-guided fiberoptic intubation in patients with unanticipated difficult airway.

The Role of Airway Management on Feeding Difficulties in Children With Pfeiffer Syndrome.

Pfeiffer syndrome is characterized by craniosynostosis, mid-face hypoplasia, broad thumbs, and often multilevel airway obstruction. Airway management is often required, including the use of positive airway ventilation, nasopharyngeal airway (NPA), or tracheostomy. The objective of this study was to assess the impact an airway adjunct can have on feeding difficulties in children with Pfeiffer syndrome. Retrospective review of patients diagnosed with Pfeiffer syndrome from January 1998 to January 2020 at one of England's 4 supraregional Craniofacial Units, Alder Hey Children's Hospital. Speech & Language Therapy case notes and medical notes were used to gather data, as well as the Oral Feeding Score component of the UK Craniofacial Outcome Score. Eleven patients were included. Six patients had no airway adjunct (55%): 3 had tracheostomy (27%) and 2 patients had NPA (18%). All patients with airway adjuncts were percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy fed. Those who did not require an airway adjunct had an Oral Feeding Score of 4.60 (SD: 0.49). The children who went on to have an airway adjunct had a mean preintervention Oral Feeding Score of 2.4 (SD: 0.8). The mean feeding score (postairway adjunct) in the NPA group was 2.0, compared with the tracheostomy group scoring 3.0. Children with Pfeiffer syndrome who require airway intervention have more significant feeding problems requiring feeding intervention. Although there were small numbers included in this study, there is a suggestion that airway adjuncts can contribute to feeding difficulties, particularly NPAs.

Airway Management: The Current Role of Videolaryngoscopy.

Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.

Airway Management in COVID- 19 Patients

The first case found in 31 December 2019 in China, in Wuhan city but China reported this news to WHO in January 2020 after this corona virus can spread worldwide, and WHO declare this disease as a pandemic. As per survey now over the 4,444,670 cases of Covid-19 can identified in 188 countries globally and 1,588,858 can recovery rate of this disease worldwide. Corona virus can caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2), is a single standard ribonucleic acid that enclose to corona virus and it is very infectious and spreading all over the world. It can be transmitted or spreading by droplets and come to direct contact with the patients compare to airborne spread. There is no any specific treatment strategy for corona virus, only supportive therapies such as respiratory care to the severe or acute patients, it’s especially in severe condition.&#x0D; Aim is to provide airway management to COVID 19 patients and what is the role of airway management in this patient condition. This can provide issues with the person who severely suffering from respiratory diseases in hospital settings. The COVID 19 predominantly causing infection like pneumonia. At the time of giving intervention for managing the patient with severe respiratory condition are managed by mainly tracheal intubation and forming a controlled ventilation. As far this disease condition can increase, there will be the many community people are not having any symptoms of COVID 19 but after few days or week, they showing symptoms. Then they patients come under the emergency services.

Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review

&lt;p class="abstract"&gt;Tracheostomy often plays a crucial role in airway management of the patients in intensive critical unit (ICU). Tracheostomy is often helpful for improvement of the respiratory mechanics and the patient comfort. There are several advantages of the trachesotomy over the endotracheal tube intubation such as avoidance of the injury of the larynx, provide a stable airway, facilitates pulmonary toilet and facilitates ventilation. It has been suggested that tracheostomy also helpful to reduce the risk of ventilator associated pneumonia (VAP) in comparison to the trans-laryngeal intubation. VAP is a type of nosocomial infection which has been associated with presence of mechanical ventilation. Despite significant improvement in managing the intubated patients, VAP remains a common and sometimes fatal complication in the ICU. Clinician’s attitude towards trachesotomy may be still heterogeneous in ICU and the decision for performing tracheostomy is still challenging. However, early tracheostomy is associated with less VAP, less ICU stay, avoid higher number of intubation in early group of tracheostomy and higher patient comfort. The purpose of this review article was to discuss the etiopathology of VAP, epidemiology, role of early tracheostomy in VAP and prevention of the VAP in patients with mechanical ventilation in ICU.&lt;/p&gt;

EVALUATION OF AEROSOL DRUG DELIVERY DURING MANUAL RESUSCITATION IN ADULT AND PEDIATRIC PATIENTS

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The aim of this study was to compare the aerosol delivery from a vibrating mesh nebuliser (VMN) and a jet nebuliser (JN) using a manual resuscitation bag (MRB) in adult and pediatric patients. METHODS: A 2.5ml dose of 1mg/ml of salbutamol (GlaxoSmithKline Ltd., Ireland) was aerosolised as a tracer aerosol with a VMN (Aerogen Solo, Aerogen, Ireland) and a JN (Philips SideStream, Philips, Netherlands). The JN was operated at a standard driving gas flow rate of 7 LPM and run until sputter + 1 minute for each test scenario. The nebulisers were placed distal to an endotracheal tube, (ETT) (adult ID 8.0mm, paediatric ID 5.0mm, Flexicare Medical Ltd, UK). The respiratory circuit was driven by an MRB (Ventlab Airflow 1500ml adult and 550ml paediatric MRB, SunMed LLC, USA) at a rate of 20 BPM and an inspiratory:expiratory ratio (I:E) of 1:2 for both patient cohorts. These breathing rates are on the upper and lower end of the ranges for adult and paediatric patients; however, a BR of 20 BPM and an I:E of 1:2 is considered normal in both patient types [2]. To ensure consistency of dose delivery the same user operated the MRB for each test. A capture filter (Respigard, Baxter, Ireland) was placed between the ETT and a test lung (IMT SmartLung, IMT Analytics, Switzerland). The mass of drug delivered was determined using UV spectrophotometry at 276nm. Results, indicating the dose delivered to the patient, are expressed as the percentage of the nominal dose placed in the nebuliser’s medication cup. A paired t-test analysis was carried out to determine significance of results. Significance was considered at p≤0.05. RESULTS: The use of the VMN resulted in a higher delivered lung dose (%) compared to the JN when used in combination with both the adult (13.19% ± 0.63% VMN versus 3.05% ± 0.33% JN, p = 0.00) and pediatric (3.13% ± 0.34% VMN versus 1.17% ± 0.31% JN, p = 0.034) resuscitation bags. CONCLUSIONS: These findings indicate that the nebuliser type had a significant effect on the efficiency of aerosol delivery to an intubated patient using an MRB, p≤0.05. The VMN delivered significantly more aerosol than the JN in both adult and pediatric patients. CLINICAL IMPLICATIONS: Manual resuscitation plays a pivotal role in airway management and potentially in determining patient outcomes [1]. Medical aerosols can be administered to a patient to stabilize the airways and can be delivered in combination with a manual resuscitation bag. The choice of nebuliser may influence the efficiency of aerosol delivered to the patient.

The difficult airway in severe facial trauma

Consideration of the airway is paramount in management of facial fractures in both the acute setting and delayed repair. As experts in laryngotracheal surgery, otolaryngologists often play a key role in airway management in both settings. On presentation, soft tissue edema and prolapse or presence of blood in the airway may complicate placement of an endotracheal tube and may necessitate emergent intervention. During planned fracture repair, surgeons and anesthesiologists must collaborate to determine a precise airway plan due to the inherent conflict of a need for a secure airway and a need for surgical access. It is our goal to review current techniques for securing the difficult airway in these patients.

The Impact of Tracheostomy Timing on the Duration and Complications of Mechanical Ventilation

Background: Mechanical ventilation is a life support for ICU patients and is indicated in case of acute or chronic respiratory failure. 75% of patients admitted to ICU require this support and most of them stay on prolonged MV. Tracheostomy plays a fundamental role in airway management, facilitating ventilator weaning and reducing the duration of MV. Early tracheostomy is defined when the procedure is conducted up to 10 days after the beginning of MV and late tracheostomy when the procedure is performed after this period. Controversy still exists over the ideal timing and classification of early and late tracheostomy. Objective: Evaluate the impact of timing of tracheostomy on ventilator weaning. Method: Single-center retrospective study. Patients were divided into three groups: very early tracheostomy (VETrach), intermediate (ITrach) and late (LTrach): &gt;10 days. Results: One hundred two patients were included: VETrach (n=21), ITrach (n=15), and LTrach (n=66). ITrach group had lower APACHE II (p=0.004) and SOFA (p≤0.001). Total ICU length of stay, and incidence of post-tracheostomy ventilator-associated pneumonia were significantly lower in the VETrach and ITrach groups. The GCS and RASS scores improved in all groups, while the maximal inspiratory pressure and rapid shallow breathing index showed a tendency towards improvement on discharge from the ICU. Conclusion: Very early tracheostomy did not reduce the duration of MV or length of ICU stay after the procedure when compared to late tracheostomy, but was associated with low rates of ventilatorassociated pneumonia. Neurological patients benefitted more from tracheostomy, particularly very early and intermediate tracheostomy.

Evaluation of successful insertion of cobra-perilaryngeal airway and laryngeal mask airway supreme by novice anaesthesiologists: Experience from a teaching institute

Background and Aim: Because of its simplicity of insertion, supraglottic airway (SGA) plays an important role in airway management. This study was planned to compare success rate within two attempts at correct placement of Cobra perilaryngeal airway (C-PLA) with laryngeal mask airway Supreme (S-LMA) by novice anaesthesiologists. Secondary objectives included the comparison of time to insertion, ease of insertion and incidence of complications with the device. Methods: The trial was approved by the Institutional Review Board and registered with the Clinical Trials Registry-India (CTRI/2014/08/004913). Fourteen eligible and consenting novice anaesthesiologists were included. Each trainee had to insert each SGA for 5 successful times on the Laerdal airway trainer. After obtaining informed consent, 112 adult patients undergoing elective surgery were randomised to the anaesthesiologists and the SGA device. Induction of general anaesthesia was standardised. Only 2 attempts at insertion of SGA were allowed. Ease of insertion by novices was recorded using a numerical rating scale (NRS) 1 to 10 (10 = easiest). Data were entered into IBM SPSS software version 21.0 (IBM, NY, USA). Categorical data were compared using Chi-square test, while scores were analysed using Mann-Whitney test. Results: There was no difference in success rate between S-LMA (91%) and C-PLA (89%) (P = 0.75). Median time (interquartile range) of insertion for S-LMA was 30 (25–34) seconds and C-PLA was 29 (25–32) seconds (P = 0.53). The incidence of complications was similar for both devices. Novices rated insertion of C-PLA NRS score of 8 (7–9) significantly easier than S-LMA NRS score 7 (5–9) (P = 0.0005). Conclusion: Although the success rate of insertion and time to insertion of C-PLA is similar to S-LMA, novices found C-PLA easier to insert.

Effects of Intravenous and Inhaled Nebulized Lignocaine on the Hemodynamic Response of Endotracheal Intubation Patients: A Randomized Clinical Trial.

Background:Endotracheal intubation is one of the most common measures in the Intensive Care Unit (ICU) which plays an important role in airway management of the critically ill patients.Aims:The study aimed to evaluate the effects of lignocaine spray on hemodynamic response of endotracheal intubation patients.Settings and Design:This study is a randomized clinical trial on a study population comprising patients admitted to the ICU.Subjects and Methods:The patients were divided into three groups using a permuted block randomization. In Group 1, inhaled nebulized lignocaine 4% (75.0 mg/kg) was sprayed around the patients’ epiglottis and larynx. In Group 2, intravenous (IV) lignocaine 2% (75.0/mg/kg) was injected. No lignocaine was prescribed for or administered to the control group. One and four minutes after intubation, the patients’ hemodynamic and vital signs were measured.Statistical Analysis Used:Data analysis was run using Stata 13 software through repeated measure ANOVA tests.Results:Although the mean arterial blood pressure (MAP) of Group 1 (inhaled nebulized lignocaine) was smaller than that of Group 2 (IV lignocaine), there was no significant difference between the two groups. Both groups’ MAPs were significantly different from that of the control group. As for the average number of pulses, a significant difference was observed between the inhaled and IV lignocaine groups; hence, the average number of pulses in Group 1 (inhalation) was lower than that of Group 2 (IV injection).Conclusion:As blood pressure is considered to be normal under 140/90 and may not entail any hemodynamic complications, it can be concluded that inhaled nebulized lignocaine can control the hemodynamic changes of intubation more effectively than IV lignocaine.

Has Video Laryngoscopy Improved First Pass and Overall Intubation Success in the University of Florida Health Emergency Department?

Airway management is an integral skill for emergency medicine physicians and is a significant part of residency training [1]. Direct laryngoscopy (DL) has been the mainstay of clinical practice for airway management. With the introduction of video laryngoscopy (VL), the emergency medicine (EM) community has embraced what was initially a difficult airway adjunct and is now moving towards becoming a standard of care, particularly for difficult airways [2-4]. The ultimate place of video laryngoscopy in EM airway management is at this time undecided. Airway management is a high risk procedure in EM populations; the risks associated with intubation in coding, hypotensive, or traumatized patients are significant and appropriately using the many adjuncts available can prevent an airway catastrophe [5-7]. Learning to properly use first line management techniques as well as adjunctive devices is an important part of everyday practice and residency training [8]. As an initial skill every EM resident learns is how to utilize DL for endotracheal intubation; however in the training period it can be difficult to communicate verbally what is being observed visually in the high stress environment of crash intubations. VL can serve as a method to allow increasing independence, as it offers the ability to practice DL for the operator and provides continuous indirect video for observers of the procedure, so feedback can occur in real time to the operator. VL has been shown to improve first pass success and time to intubation for novice operators but not for experienced operators [9]. Research has shown that repeated intubation attempts predict worse outcomes, namely hypoxic insults, cardiac arrest, aspiration, need for surgical airway, and increased mortality overall [10-12]. VL was re-introduced in this institution’s emergency department in January 2013 and since its role in airway management was relatively new, an evaluation of the use of VL in this ED was considered to be timely and important, given the fact that many attending providers were becoming accustomed to using this modality for all airways, including those deemed to not be critical in nature.

Simulation for Airway Management in a Critical Care Set Up

The simulators have been used conventionally by pilot training wherein real time scenario and crisis situation is created for management. Similar concept has been recently extended in medical sciences for teaching and training and has found an important role in airway management as well. Simulators are inevitable for learning the technical skills and aids in learning and assessing psychomotor tasks, cognitive and affective skills [1,3,4,7,8]. Simulation practice ensures team dynamics along with application of algorithmic approach for holistic management. Traditionally airway management training was delivered by practicing skills like laryngoscopy, fiberscopic tracheal intubation individually. In real scenario, these individuals’ skills need to be choreographed into an systematic approach. We need to have primary approach for airway management, secondary approach, if it fails and also subsequent rescue approaches. This real time airway management may not be possible in airway trainers by learning individual skills. The algorithms have been proposed by various professional bodes for management of airway [1]. The stimulators would help to acquire the skills and judgment of the equipments and techniques required of the algorithm [1]. The simulators in airway management helps in improving psychomotor level (skill training), cognitive level (decision making) or affective level (interacting with peers/coworkers) [1] The simulators are an important tool for evaluation of efficacy of training and skill retention [1,2,9]. In view of ethical concerns and patient safety, simulator training would become essential prior to interacting with real patients as compared to training on real patients. The simulator available are either partial-task or whole-task trainers or may replicate real time conditions without compromising the patient safety [1]. Though the animal models were initially used for these concerns, but many aspects of real time situations were not feasible in such models [1]. The high-fidelity patient simulation reproduce real-life patient and a similar environment may be created as to be encountered by the learners. Such environment may be considered as sensitizer for the learners for real time stressful situations to handle difficult airway situations in critically ill patient. Unlike real patients, a high-fidelity airway simulator provides various opportunities for different type of airway difficulties and complications. This provides learners an opportunity to perform multiple times under different conditions.

Elective use of supraglottic airway devices for primary airway management in children with difficult airways

Supraglottic airways (SGAs) have an established role in airway management of difficult airways in both adults and children. However, there are limited data regarding the use of SGAs for primary airway management in children. The aim of this study is to assess the success rates and adverse events related to the use of SGAs for primary airway management during anaesthesia in children with difficult airways. A retrospective analysis of SGA use for primary airway management in the difficult airway population in a single centre over a 4-yr period was performed. Difficult airway was defined as either a history of difficult direct laryngoscopy (a documented Cormack and Lehane Grade 3 or greater and the need for an alternate device to direct laryngoscopy for successful tracheal intubation), a history of difficult mask ventilation, or both. The difficult airway condition, patient characteristic data, type and length of procedure, type and size of SGA placed, number of attempts for successful device placement, success/failure associated with the device during anaesthetic maintenance, and complications were recorded. A total of 77,272 children received general anaesthesia in a free-standing paediatric institution. Four hundred and fifty-nine patients were reported to have a difficult airway. Of those, 109 received general anaesthesia and an SGA for primary management, meeting the inclusion criteria for this study during a 4-yr period. An SGA was successfully used in 96% of these patients. In four patients, an alternative airway was needed. SGAs can be effectively utilized for airway maintenance in the paediatric difficult airway population.

Cadaver Study of Oesophageal Insufflation With Supraglottic Airway Devices During Positive Pressure Ventilation in an Obstructed Airway

Background Supraglottic airway devices (SADs) play an increasing role in airway management in clinical anaesthesia and emergency medicine. Until now, no data exist concerning the extent of oesophageal insufflation when oropharyngeal leak pressures are exceeded. Methods Laryngeal masks LMA-Supreme™ and LMA-ProSeal™, laryngeal tubes LTS-D and LTS II, Combitube™, and I-Gel were inserted into unfixed human cadavers. The oesophagus was connected to a volumeter, while the trachea was closed surgically to simulate complete airway obstruction. Volumes of oesophageal insufflation resulting from pressure-controlled ventilation at inspiratory pressures of 20, 40, and 60 mbar were measured. Results No oesophageal insufflation could be detected at a ventilation pressure of 20 mbar in any device. Using inspiratory pressures of 40 and 60 mbar, oesophageal insufflation occurred in all devices, with significantly higher volumes of intraoesophageal air for both laryngeal tubes. Conclusions The use of SADs with inspiratory pressures of 20 mbar appears to be safe regarding the risk of intragastric insufflation. Higher inspiratory pressures should be strictly avoided.

Cadaver study of oesophageal insufflation with supraglottic airway devices during positive pressure ventilation in an obstructed airway

Supraglottic airway devices (SADs) play an increasing role in airway management in clinical anaesthesia and emergency medicine. Until now, no data exist concerning the extent of oesophageal insufflation when oropharyngeal leak pressures are exceeded. Laryngeal masks LMA-Supreme™ and LMA-ProSeal™, laryngeal tubes LTS-D and LTS II, Combitube™, and I-Gel were inserted into unfixed human cadavers. The oesophagus was connected to a volumeter, while the trachea was closed surgically to simulate complete airway obstruction. Volumes of oesophageal insufflation resulting from pressure-controlled ventilation at inspiratory pressures of 20, 40, and 60 mbar were measured. No oesophageal insufflation could be detected at a ventilation pressure of 20 mbar in any device. Using inspiratory pressures of 40 and 60 mbar, oesophageal insufflation occurred in all devices, with significantly higher volumes of intraoesophageal air for both laryngeal tubes. The use of SADs with inspiratory pressures of 20 mbar appears to be safe regarding the risk of intragastric insufflation. Higher inspiratory pressures should be strictly avoided.

Video‐laryngoscopes in the adult airway management: a topical review of the literature

The aim of the present paper is to review the literature regarding video-laryngoscopes (Storz V-Mac and C-Mac, Glidescope, McGrath, Pentax-Airway Scope, Airtraq and Bullard) and discuss their clinical role in airway management. Video-laryngoscopes are new intubation devices, which provide an indirect view of the upper airway. In difficult airway management, they improve Cormack-Lehane grade and achieve the same or a higher intubation success rate in less time, compared with direct laryngoscopes. Despite the very good visualization of the glottis, the insertion and advancement of the endotracheal tube with video-laryngoscopes may occasionally fail. Each particular device's features may offer advantages or disadvantages, depending on the situation the anaesthesiologist has to deal with. So far, there is inconclusive evidence indicating that video-laryngoscopy should replace direct laryngoscopy in patients with normal or difficult airways.

Early postoperative alterations of ventilation parameters after tracheostomy in major burn injuries.

Purpose: In patients with major burn injuries mechanical ventilation is often required for longer periods. Tracheostomy (TS) plays an integral role in airway management. We investigated the effect of TS on ventilation parameters within 8 hours after TS.Materials: A retrospective analysis of severely burned patients admitted to the burn unit of a German University Hospital was performed. Ventilation parameters 8 hours before and after TS were registered. Results: A retrospective analysis of 20 patients which received surgical TS was performed. Mean age was 52±19 years. Mean abbreviated burned severity index (ABSI) was 8.3±2.2. A mechanical ventilation was required for 14.3±4.8 days. TS was performed on day 7±4. Inspiratory oxygen concentration (FiO2) (p<0.001), peak inspiratory pressure (p<0.001), positive end-expiratory pressure (p=0.003) and pulmonary resistance (p<0.001) were reduced significantly after TS. The arterial partial pressure of oxygen/FiO2-ratio increased significantly after TS (p<0.001).Conclusions: We demonstrate that TS reduces invasiveness of ventilation in severely burned patients and by this can optimize lung protective ventilation strategy.

Video Laryngoscopy in the Prehospital Setting

In the prehospital setting, the emergency care provider must anticipate that some patients will manifest with difficult airways. The use of video laryngoscopy to secure an airway in the prehospital setting has not been explored widely, but has the potential to be a useful tool. This article briefly reviews some of the major video laryngoscopes on the market and their usefulness in the prehospital setting. Studies and case reports indicate that the video laryngoscope is a promising device for emergency intubation, and it has been predicted that, in the future, video laryngoscopy will dominate the field of emergency airway management. Direct laryngoscopy always should be retained as a primary skill; however, the video laryngoscope has the potential to be a good primary choice for the patient with potential cervical spine injuries or limited jaw or spine mobility, and in the difficult-to-access patient. The role of video laryngoscopes in securing an airway in head and neck trauma victims in the prehospital setting has yet to be determined, but offers interesting possibilities. Further clinical studies are necessary to evaluate its role in airway management by prehospital emergency medical services.

Disposable Laryngeal Mask Performs Well

The laryngeal mask airway (LMA classic) has an established role in airway management for elective anesthesia and as a rescue device in certain difficult- or failed-intubation situations. With expiration of its patent, a number of alternative laryngeal mask airways are becoming available. Researchers assessed the performance of a new disposable laryngeal mask airway (Ambu LMA) in 118 elective anesthesia patients in an international, multicenter …