Mask Ventilation, Direct Laryngoscopy, and Supraglottic Airway Placement Procedures

2021 ◽  
pp. 17-36
Author(s):  
Jennifer Anderson
Keyword(s):  
Airway Management ◽  
Direct Laryngoscopy ◽  
Respiratory Arrest ◽  
Supraglottic Airway ◽  
Spontaneous Respiration ◽  
Positive Pressure ◽  
Mask Ventilation ◽  
Airway Patency ◽  
Bag Mask Ventilation ◽  
Respiratory Assistance

The basic skills required for competence in pediatric airway management include mask ventilation, supraglottic airway placement, direct laryngoscopy, and intubation. Although techniques used for children are similar to those used for adults, there are some nuances that pertain only to the pediatric patient. This chapter describes and illustrates these basic airway management procedures for pediatric patients. Bag mask ventilation is used extensively in the operating room, emergency department, and intensive care unit. Effective bag mask ventilation can save a child’s life in emergent situations.1 Respiratory assistance is provided to the patient through a mask on the patient’s face, held in a specialized way to maximize airway patency (described later), that is attached to a device capable of delivering positive pressure manually or automatically. Oxygenation is achieved by compressing air/oxygen through the delivery device into the lungs, and ventilation is ensured by maintaining airway patency as the patient exhales with chest wall recoil. Intubation is indicated in any patient who is unable to maintain adequate spontaneous respiration or who is at risk for aspiration. Examples are patients in respiratory arrest, those in cardiac arrest, or sometimes those experiencing neurologic issues such as seizures. Patients undergoing surgical procedures will often require intubation because of the apnea and risk for aspiration caused by the anesthetics and the surgical procedure itself.

Airway Management

2019 ◽  
Author(s):  
James M. Dargin ◽  
Lillian L. Emlet
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Critically Ill Patients ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Bag Mask Ventilation ◽  
Upper Gastrointestinal

Endotracheal intubation is a commonly performed procedure in the intensive care unit (ICU). Active upper gastrointestinal bleeding, emesis in the airway, and the presence of a cervical collar are just a few examples of conditions encountered in critically ill patients that can make endotracheal intubation difficult. Furthermore, critically ill patients usually require intubation because they have exhausted their physiologic reserve and can deteriorate rapidly due to vasodilation from induction medications, reduction in preload from positive pressure ventilation, hypercapnia and acidosis during periods of apnea, hypoxia from failed attempts at intubation, and an increase in intracranial pressure during laryngoscopy attempts. Up to one third of patients undergoing emergency airway management will develop serious complications, including hypoxemia, hypotension, aspiration, or cardiac arrest. Careful planning, provision of the appropriate equipment and personnel, and an understanding of an individual patient’s physiologic derangements can help to prevent complications during intubation.  This review 13 figures, 4 tables, and 27 references.  Keywords: airway, intubation, endotracheal, rapid sequence, pre-oxygenation, bag-mask ventilation, laryngoscopy, cricothyrotomy, supraglottic airway 

scholarly journals Airway Management: The Less Popular Skill of Bag-mask Ventilation

2018 ◽  
Vol 129 (5) ◽  
pp. 1049-1050
Author(s):  
Gerald P. Rosen ◽  
Omar Viswanath ◽  
Jason C. Wigley ◽  
Bryan Kerner
Keyword(s):  
Airway Management ◽  
Mask Ventilation ◽  
Bag Mask Ventilation

Bag-mask ventilation and direct laryngoscopy versus intubating laryngeal mask airway

2014 ◽  
Vol 21 (3) ◽  
pp. 189-194 ◽  
Author(s):  
Sebastian G. Russo ◽  
Christoph Stradtmann ◽  
Thomas A. Crozier ◽  
Christiane Ringer ◽  
Hans-Joachim Helms ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Direct Laryngoscopy ◽  
Laryngeal Mask ◽  
Mask Ventilation ◽  
Intubating Laryngeal Mask Airway ◽  
Bag Mask Ventilation

Prediction of Difficult Mask Ventilation

2000 ◽  
Vol 92 (5) ◽  
pp. 1229-1236 ◽  
Author(s):  
Olivier Langeron ◽  
Eva Masso ◽  
Catherine Huraux ◽  
Michel Guggiari ◽  
André Bianchi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Multivariate Analysis ◽  
Confidence Interval ◽  
Body Mass ◽  
Univariate Analysis ◽  
Positive Pressure ◽  
Mask Ventilation ◽  
Airway Patency ◽  
Difficult Mask Ventilation ◽  
History Of

Background Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Because the incidence of difficult mask ventilation (DMV) and the factors associated with it are not well known, we undertook this prospective study. Methods Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia. A univariate analysis was performed to identify potential factors predicting DMV, followed by a multivariate analysis, and odds ratio and 95% confidence interval were calculated. Results A total of 1,502 patients were prospectively included. DMV was reported in 75 patients (5%; 95% confidence interval, 3.9-6.1%), with one case of impossible ventilation. DMV was anticipated by the anesthesiologist in only 13 patients (17% of the DMV cases). Body mass index, age, macroglossia, beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance were identified in the univariate analysis as potential DMV risk factors. Using a multivariate analysis, five criteria were recognized as independent factors for a DMV (age older than 55 yr, body mass index > 26 kg/m2, beard, lack of teeth, history of snoring), the presence of two indicating high likelihood of DMV (sensitivity, 0.72; specificity, 0.73). Conclusion In a general adult population, DMV was reported in 5% of the patients. A simple DMV risk score was established. Being able to more accurately predict DMV may improve the safety of airway management.

Abstract 163: Type of Prehospital Airway Management Does Not Affect Chest X-Ray Abnormality in Resuscitated Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiromichi Naito ◽  
Atsunori Nakao ◽  
Alexandra Weissman ◽  
Jonathan Elmer ◽  
Christian Martin-Gill ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Thoracic Imaging ◽  
X Ray ◽  
Significant Difference ◽  
Chest X Ray ◽  
Prehospital Airway Management ◽  
Hospital Cardiac Arrest

Introduction: Chest x-ray (CXR) abnormalities after cardiopulmonary resuscitation are common. Mechanisms by which these abnormalities develop are not fully elucidated, but aspiration of secretions and regurgitated gastric contents during prehospital airway management may be an important modifiable cause. Hypothesis: We hypothesized that endotracheal intubation (ETI) is associated with decreased incidence of CXR abnormalities after out-of-hospital cardiac arrest (OHCA), as compared to bag-valve-mask (BVM) or supraglottic airway (SGA) use. Methods: We conducted a retrospective review including resuscitated OHCA patients treated at a single academic medical center from 2010-2015. We included patients that had an initial CXR obtained within 66 hours of arrival. We excluded patients with tracheostomy, patients without positive pressure ventilation on emergency department (ED) arrival, or missing initial airway management data. We classified patients by airway management at the time of ED arrival into three groups: BVM, SGA, and ETI. Board certified thoracic imaging radiologists determined if there was any CXR abnormality, and if the observed abnormality was likely due to aspiration. The incidence of any abnormality and aspiration were compared between groups. A multivariable logistic regression model was used to adjust for baseline clinical characteristics. Results: Of the 766 subjects included in the study, 22 (3%) had BVM, 68 (9%) had SGA, and 676 (88%) had ETI. Most 58% were male, 34% had initial rhythm VF/VT, and 61% had a witnessed arrest. Any abnormality on CXR was identified in 543 (71%) cases, and likely aspiration was observed in 205 (27%) cases. Incidence of CXR abnormality was not significantly different between groups: BVM group 18/22 (82%), reference; SGA group 52/68 (76%), OR 0.75, 95% CI 0.13-4.31; ETI group 473/676 (70%), OR 0.81, 95% CI 0.16-4.01. Incidence of aspiration on CXR was also not different between groups: BVM group 6/22 (27%), reference; SGA group 19/68 (28%), OR 1.04, 95% CI 0.18-6.22; ETI group 180/676 (27%), OR 1.26, 95% CI 0.25-6.32. Conclusion: Prehospital airway management strategy for resuscitated OHCA patients was not associated with a significant difference in the incidence of any abnormality or aspiration on CXR.

scholarly journals Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial

2020 ◽  
Vol 9 (7) ◽  
pp. 2045
Author(s):  
Lea Vogt ◽  
Timur Sellmann ◽  
Dietmar Wetzchewald ◽  
Heidrun Schwager ◽  
Sebastian Russo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Airway Management ◽  
Chest Compression ◽  
Observational Studies ◽  
Cumulative Effect ◽  
Mask Ventilation ◽  
Advanced Airway ◽  
Bag Mask Ventilation ◽  
Lower Adherence

The role of advanced airway management (AAM) in cardiopulmonary resuscitation (CPR) is currently debated as observational studies reported better outcomes after bag-mask ventilation (BMV), and the only prospective randomized trial was inconclusive. Adherence to CPR guidelines ventilation recommendations is unknown and difficult to assess in clinical trials. This study compared AAM and BMV with regard to adherence to ventilation recommendations and chest compression fractions in simulated cardiac arrests. A total of 154 teams of 3–4 physicians were randomized to perform CPR with resuscitation equipment restricting airway management to BMV only or equipment allowing for all forms of AAM. BMV teams ventilated 6 ± 6/min and AAM teams 19 ± 8/min (range 3–42/min; p < 0.0001 vs. BMV). 68/78 BMV teams and 23/71 AAM teams adhered to the ventilation recommendations (p < 0.0001). BMV teams had lower compression fractions than AAM teams (78 ± 7% vs. 86 ± 6%, p < 0.0001) resulting entirely from higher no-flow times for ventilation (9 ± 4% vs. 3 ± 3 %; p < 0.0001). Compared to BMV, AAM leads to significant hyperventilation and lower adherence to ventilation recommendations but favourable compression fractions. The cumulative effect of deviations from ventilation recommendations has the potential to blur findings in clinical trials.

scholarly journals Airway management of an open penetrating neck injury

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 89-93 ◽  
Author(s):  
Nayer Youssef ◽  
Karen E. Raymer
Keyword(s):  
High Risk ◽  
Airway Management ◽  
Rapid Sequence Intubation ◽  
Positive Pressure ◽  
Small Subset ◽  
Global Management ◽  
Airway Injury ◽  
Rapid Sequence ◽  
Penetrating Neck Injury ◽  
Bag Mask Ventilation

AbstractAlthough penetrating neck injuries (PNIs) represent a small subset of patients presenting to the emergency department (ED), they can result in significant morbidity and mortality. The approach to airway management in PNI varies widely according to clinical presentation and local practice, such that global management statements are lacking. Although rapid sequence intubation (RSI) may be safe in most patients with PNI, the high-risk subset (10%) of patients with laryngotracheal injury require particularly judicious airway management. It is not known if RSI is safe in such patients, nor has there been reported use of videolaryngoscopy in patients with open PNI. Established principles of airway management in patients with an open airway injury include the avoidance of both positive pressure bag-mask ventilation and blind tube passage and the early consideration of a surgical airway. Because this high-risk subset may not be clinically apparent on initial presentation in the ED, such guiding principles apply to all patients with PNI until the nature of the injury is more accurately defined. In this report, we present the case of a patient who presented to the ED with a zone II open PNI, which occurred as a result of a stab wound.

scholarly journals Novices Ventilate and Intubate Quicker and Safer via  Intubating Laryngeal Mask Than by Conventional Bag–Mask Ventilation and Laryngoscopy

2007 ◽  
Vol 107 (4) ◽  
pp. 570-576 ◽  
Author(s):  
Arnd Timmermann ◽  
Sebastian G. Russo ◽  
Thomas A. Crozier ◽  
Christoph Eich ◽  
Birgit Mundt ◽  
...  
Keyword(s):  
Medical Students ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Medical Personnel ◽  
Laryngeal Mask ◽  
Mask Ventilation ◽  
Success Rates ◽  
Management Techniques ◽  
Bag Mask Ventilation ◽  
Randomized Crossover Study

Background Because airway management plays a key role in emergency medical care, methods other than laryngoscopic tracheal intubation (LG-TI) are being sought for inadequately experienced personnel. This study compares success rates for ventilation and intubation via the intubating laryngeal mask (ILMA-V/ILMA-TI) with those via bag-mask ventilation and laryngoscopic intubation (BM-V/LG-TI). Methods In a prospective, randomized, crossover study, 30 final-year medical students, all with no experience in airway management, were requested to manage anesthetized patients who seemed normal on routine airway examination. Each participant was asked to intubate a total of six patients, three with each technique, in a randomly assigned order. A task not completed after two 60-s attempts was recorded as a failure, and the technique was switched. Results The success rate with ILMA-V was significantly higher (97.8% vs. 85.6%; P &lt; 0.05), and ventilation was established more rapidly with ILMA-V (35.6 +/- 8.0 vs. 44.3 +/- 10.8 s; P &lt; 0.01). Intubation was successful more often with ILMA-TI (92.2% vs. 40.0%; P &lt; 0.01). The time needed to achieve tracheal intubation was significantly shorter with ILMA-TI (45.7 +/- 14.8 vs. 89.1 +/- 23.3 s; P &lt; 0.01). After failed LG-TI, ILMA-V was successful in all patients, and ILMA-TI was successful in 28 of 33 patients. Conversely, after failed ILMA-TI, BM-V was possible in all patients, and LG-TI was possible in 1 of 5 patients. Conclusion Medical students were more successful with ILMA-V/ILMA-TI than with BM-V/LG-TI. ILMA-TI can be successfully used when LG-TI has failed, but not vice versa. These results suggest that training programs should extend the ILMA to conventional airway management techniques for paramedical and medical personnel with little experience in airway management.

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