Airway Management (DRAFT)

2018 ◽  
Author(s):  
James M. Dargin ◽  
Lillian L. Emlet
Keyword(s):  
Airway Management ◽  
Severe Respiratory Failure ◽  
Rapid Response Teams ◽  
Clinical Context ◽  
Careful Planning ◽  
Respiratory Status ◽  
Management Interventions ◽  
Hospital Environments ◽  
Advanced Airway ◽  
Increased Risk

Deterioration in respiratory status is the most common reason for activation of rapid response teams (RRT). Severe respiratory failure may necessitate advanced airway management interventions including endotracheal intubation (ETI) in hospital environments that may be especially challenging in clinical context, space, equipment, and personnel. Furthermore, patients undergoing ETI during the course of an RRT event are critically ill, identifying them as patients who are at increased risk for adverse events during the procedure. Many of the challenges of airway management during RRT events can be overcome with appropriate staffing, proper equipment, and careful planning prior to attempts at ETI. In this chapter, we discuss the evaluation and management of patients requiring ETI during the RRT event including recommendations on pharmacology and intubation techniques.

scholarly journals A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber

2020 ◽  
Vol 48 (10) ◽  
pp. 2371-2376
Author(s):  
Lauren M. Maloney ◽  
Ariel H. Yang ◽  
Rudolph A. Princi ◽  
Alexander J. Eichert ◽  
Daniella R. Hébert ◽  
...  
Keyword(s):  
Airway Management ◽  
Resource Constraints ◽  
Healthcare Providers ◽  
Airborne Particles ◽  
Management Innovation ◽  
Efficacy Evaluation ◽  
Management Interventions ◽  
Hospital Environments ◽  
3D Printed ◽  
Pvc Pipe

Abstract The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient’s body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.

Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases

2020 ◽  
Vol 24 (5) ◽  
Author(s):  
Carla Hipólito ◽  
Vicente Vieira ◽  
Virginia Antunes ◽  
Petra Alves ◽  
Adriana Rodrigues ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Airway Management ◽  
Inguinal Hernia Repair ◽  
Neuromuscular Blockade ◽  
Retrospective Review ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Laparoscopic Inguinal Hernia ◽  
Increased Risk ◽  
The Mean

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia. Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management. Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade. Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade. Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5): Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020

Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia

2021 ◽  
Vol 6 (3) ◽  
pp. 24-30
Author(s):  
Amani Alenazi ◽  
Bashayr Alotaibi ◽  
Najla Saleh ◽  
Abdullah Alshibani ◽  
Meshal Alharbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Airway Management ◽  
Success Rate ◽  
Phase 1 ◽  
Adult Patients ◽  
Supraglottic Airway ◽  
Future Research ◽  
Phase 2 ◽  
Advanced Airway ◽  
Supraglottic Airway Devices

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management.Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs’ success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics’ perception of advanced airway management.Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1‐5 TIs or SADs a year.Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.

Advanced Airway Management in the Neurologically Injured Patient

2003 ◽  
pp. 679-700
Author(s):  
A. Gabrielli ◽  
L. J. Caruso ◽  
A. J. Layon
Keyword(s):  
Airway Management ◽  
Injured Patient ◽  
Advanced Airway

Advanced Airway Management and Use of Anesthetic Drugs

2001 ◽  
Author(s):  
Charles Smith ◽  
Ron Walls ◽  
David Lockey ◽  
Herbert Kuhnigk
Keyword(s):  
Airway Management ◽  
Anesthetic Drugs ◽  
Advanced Airway

scholarly journals Airway Management in the Emergency Department During Coronavirus Disease (COVID-19)

2020 ◽  
Vol 28 (2) ◽  
pp. 5-11
Author(s):  
Sohil Pothiawala
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Viral Infections ◽  
Transmission Risk ◽  
National Guidelines ◽  
Hospital Policy ◽  
Resource Limited ◽  
Increased Risk ◽  
Emerging Viral Diseases ◽  
Evidence Based Guidelines

Front-line health-care workers in the Emergency Department (ED) are at an increased risk of infection during the airway management of patients with known or suspected Emerging Viral Diseases (EVD) like Coronavirus Disease 2019 (COVID-19). The primary route for transmission of the virus from an infected patient to the ED staff is due to aerosolized droplets, and the transmission risk is high despite wearing adequate Personal Protective Equipment (PPE). There are limited evidence-based guidelines for airway management during these viral infections, especially with a focus on the principles of airway management in a busy, fast-paced ED. This article provides an overview of the principles of airway management in suspected or confirmed EVD patients, including COVID-19, particularly in the context of ED, and also considering strategies in resource limited setting. These principles should be adapted to suit your local department and hospital policy on airway management as well as national guidelines.

Abstract 168: Association Between Prehospital Advanced Airway Management for Pediatric Out-of-Hospital Cardiac Arrest and Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Masashi Okubo ◽  
Sho Komukai ◽  
Junichi Izawa ◽  
Koichiro Gibo ◽  
Kosuke Kiyohara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Airway Management ◽  
Patient Outcomes ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Time Dependent ◽  
Advanced Airway ◽  
Hospital Cardiac Arrest ◽  
Favorable Functional Outcome

Introduction: It is unclear whether prehospital advanced airway management (AAM: endotracheal intubation and supraglottic airway device placement) for pediatric patients with out-of-hospital cardiac arrest (OHCA) improves patient outcomes. Objective: To test the hypothesis that prehospital advanced airway management during pediatric OHCA is associated with patient outcomes. Methods: We conducted a secondary analysis of a nationwide, prospective, population-based OHCA registry in Japan. We included pediatric patients (<18 years) with OHCA in whom emergency medical services (EMS) personnel resuscitated and transported to medical institutions during 2014 and 2015. The primary outcome was one-month survival. Secondary outcome was one-month survival with favorable functional outcome, defined as cerebral performance category score 1 or 2. Patients who received AAM during cardiopulmonary resuscitation by EMS personnel at any given minute were sequentially matched with patients at risk of receiving AAM within the same minutes based on time-dependent propensity score calculated from a competing risk regression model in which we treated prehospital return of spontaneous circulation as a competing risk event. Results: We included 2,548 patients; 1,017 (39.9%) were infants (<1 year), 839 (32.9%) were children (1 year to 12 years), and 692 (27.2%) were adolescents. Of the 2,548, included patients, 336 (13.2%) underwent prehospital AAM during cardiac arrest. In the time-dependent propensity score matched cohort (n = 642), there were no significant differences in one-month survival (AAM: 32/321 [10.0%] vs. no AAM: 27/321 [8.4%]; odds ratio, 1.33 [95% CI, 0.80 to 2.21]) and one-month survival with favorable functional outcome (AAM: 6/321 [1.9%] vs. no AAM: 5/321 [1.6%]; odds ratio, 1.48 [95% CI, 0.41 to 5.40]). Conclusions: Among pediatric patients with OHCA, we found no associations between prehospital AAM and favorable patient outcomes.

Abstract 284: Association of Neurological Outcome and Survival With Interventions by Bystander and Emergency Medical Service for Unwitnessed Out-of-Hospital Cardiac Arrest Patient; Results From the JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Chisato Okamoto ◽  
Yoshio Tahara ◽  
Atsushi Hirayama ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Favorable Outcome ◽  
Shockable Rhythm ◽  
Advanced Airway ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Although studies have shown that bystander cardiopulmonary resuscitation (CPR) in witnessed out-of-hospital cardiac arrest (OHCA) is associated with better neurological prognosis, whether bystander and Emergency Medical Service (EMS) interventions are associated with prognosis in unwitnessed OHCA patients is not fully elucidated. We aimed to investigate the prognostic importance of bystander and EMS interventions among unwitnessed OHCA patients in Japan. Methods and Results: This study was a nation-wide population-based observational study of OHCA in Japan from 2011 to 2015 based on data from the All-Japan Utstein Registry. The outcome measures were neurological outcome and survival at 30-day. The neurologically favorable outcome was defined as Glasgow-Pittsburgh cerebral performance category score 1 or 2. First, to investigate the effectiveness of bystander interventions, we included 105,655 unwitnessed cardiogenic OHCA patients (aged 18-80 years). Of these, 1,614 (1.5%) showed neurologically favorable outcome and 3,273 (3.1%) survived at 30-day. Multivariate logistic regression analysis adjusting for age, sex, geographical region, year and EMS response time showed that bystander CPR was associated with neurologically favorable outcome (adjusted odds ratio [aOR] 1.49, 95% CI 1.35-1.65, P<0.001). Additionally, to investigate the effectiveness of EMS interventions for patients with non-shockable rhythm, we examined 43,342 patients who were performed public CPR and had the initial rhythm of pulseless electrical activity (PEA) or asystole. Of these, 101 (0.2%) showed neurologically favorable outcome and 453 (1.0%) were survival at 30-day. Advanced airway management by EMS was negatively associated with neurologically favorable outcome (aOR 0.55, 95% CI 0.37-0.81, P=0.003) and administration of epinephrine by EMS was associated with survival (aOR 2.35, 95% CI 1.89-2.92, P<0.001). Conclusions: Among unwitnessed OHCA patients, bystander CPR was associated with neurologically favorable prognosis. For unwitnessed OHCA patients with non-shockable rhythm, epinephrine administration was associated with survival, but advanced airway management was negatively associated with neurological outcome.

Improvement of Pediatric Advanced Airway Management in General Emergency Departments After a Collaborative Intervention Program

2021 ◽  
Vol 66 (12) ◽  
pp. 1866-1875
Author(s):  
Manahil Mustafa ◽  
Riad Lutfi ◽  
Hani Alsaedi ◽  
Peter Castelluccio ◽  
Kellie J Pearson ◽  
...  
Keyword(s):  
Airway Management ◽  
Emergency Departments ◽  
Intervention Program ◽  
Collaborative Intervention ◽  
Advanced Airway
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