Fifteen-minute consultation: Airway management in the acutely unwell child requiring intubation for the general paediatrician

2021 ◽  
pp. edpract-2021-322200
Author(s):  
Peter Shires ◽  
Georgina Harlow ◽  
Agata Holecova
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Interdisciplinary Teams ◽  
Shared Understanding ◽  
Failed Intubation ◽  
Team Working ◽  
General Paediatrician

Emergency endotracheal intubation is a high risk procedure in acutely unwell children and is commonly jointly managed by paediatricians and anaesthetists. This article aims to develop a shared understanding of the practicalities and language around the risk factors for difficult intubation and management of failed intubation, including the approach to situations where you cannot intubate and or cannot ventilate, to improve communication and team working between these dynamic interdisciplinary teams.

scholarly journals Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Min Ho Lee ◽  
Hyun Joo Kim
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Rescue Therapy ◽  
High Flow ◽  
Mask Ventilation ◽  
Induction Process ◽  
Management Method ◽  
Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

The difficult intubation in the ICU

2016 ◽  
Author(s):  
Michael Frass
Keyword(s):  
Intensive Care ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Emergency Situations ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Different Types ◽  
Patient Preparation ◽  
Interincisor Distance

Airway management in the intensive care unit differs from conventional controlled settings such as general anaesthesia in the operating room (OR). Due to adequate patient preparation and positioning in the OR, endotracheal intubation is usually easy to perform. However, in the intensive care setting, endotracheal intubation is often difficult or impossible because patients are not prepared and intubation is immediately necessary without sufficient time for putting together technical and pharmaceutical equipment. As an alternative, non-invasive alternate airway management may be performed. Besides non-invasive ventilation via mask or helmet, the use of Combitube®, EasyTubeTM, and different types of laryngeal mask airway are described, in order to alleviate decision-making in emergency situations such as difficult intubation, vomiting and bleeding patients, small interincisor distance, etc.

scholarly journals Expert-Performed Endotracheal Intubation-Related Complications in Trauma Patients: Incidence, Possible Risk Factors, and Outcomes in the Prehospital Setting and Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yuko Ono ◽  
Takeyasu Kakamu ◽  
Hiroaki Kikuchi ◽  
Yusuke Mori ◽  
Yui Watanabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Trauma Patients ◽  
Coma Scale ◽  
Injured Patients

The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients.

Risk Factors for Neonatal Acquired Subglottic Stenosis

1986 ◽  
Vol 95 (6) ◽  
pp. 626-630 ◽  
Author(s):  
Steven K. Dankle ◽  
David E. Schuller ◽  
Richard E. McClead
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Neonatal Intensive Care ◽  
Effective Means ◽  
Assisted Ventilation ◽  
Subglottic Stenosis ◽  
Prolonged Intubation

Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been “prolonged” intubation, although opinion varies regarding the definition of this term. Various recommendations exist that attempt to establish the limits of “safe” periods of intubation for infants. Some feel that tracheotomy is indicated when airway support is required beyond those limits. In an attempt to define important risk factors involved in the development of neonatal subglottic stenosis, a retrospective analysis of infants admitted to the Neonatal Intensive Care Unit of Columbus Children's Hospital who required intubation during a 3-year period from 1977 to 1980 was undertaken. Of 343 infants who survived hospitalization, five patients were identified as having acquired subglottic stenosis. The average duration of intubation for these five patients was 56.2 days. The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.

Awake endotracheal intubation in patients with severely restricted mouth opening- alternative devices to fiberscope: series of cases and literature review

Open Medicine ◽  
2014 ◽  
Vol 9 (6) ◽  
pp. 768-772
Author(s):  
Ewelina Gaszynska ◽  
Andrzej Wieczorek ◽  
Tomasz Gaszynski
Keyword(s):  
Literature Review ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Standard Method ◽  
Mouth Opening ◽  
Alternative Methods ◽  
Fiberoptic Intubation ◽  
Craniomaxillofacial Surgery ◽  
Awake Fiberoptic Intubation

AbstractAwake Fiberoptic Intubation (AFI) is a standard method of airway management in the case of anticipated difficult intubation. It is usually performed with the use of flexible fiberscopes. In this report we have described two methods in which alternative devices to the fiberscope were utilized for awake intubation in patients with severely restricted mouth opening scheduled for craniomaxillofacial surgery: TruView PCD and Levitan FPS. Information about the use of these devices in such conditions has not been previously published in the literature. Some of the possible advantages of these alternative methods for AFI result from the fact that they are easy to use, especially for anesthesiologists who are relatively inexperienced with fiberscope intubation procedures. Additionally, these alternatives are cheaper than fiberscopes and can be used for many AFI procedures.

Prevention of Preterm Birth

2018 ◽  
Vol 11 (2) ◽  
pp. 95-104
Author(s):  
Ivan D. Ivanov ◽  
Stefan A. Buzalov ◽  
Nadezhda H. Hinkova
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
High Risk ◽  
Medical Science ◽  
Secondary Prophylaxis ◽  
High Risk Group ◽  
Screening Methods ◽  
Perinatal Complications ◽  
Social Significance ◽  
Neonatal Deaths

Summary Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.

Behavioral Emergencies and Crises

2010 ◽  
pp. 739-762
Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

Sign in / Sign up

Export Citation Format

Share Document