scholarly journals Fiberoptic Nasotracheal Intubation in the Emergency Department for Severe Upper Airway Obstruction

2019 ◽  
Vol 2019 ◽  
Author(s):  
Joseph Watson, MSIV ◽  
◽  
Kristen M. Craig, MD ◽  
Tanya Fancy, MD ◽  
Daniel Merenda, MD ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Obstruction ◽  
Nasotracheal Intubation ◽  
Upper Airway ◽  
Upper Airway Obstruction

scholarly journals A predictive formula for difficult endotracheal intubation in the emergency department

2020 ◽  
Author(s):  
En-Chih Liao ◽  
Wen-Han Chang ◽  
Ching-Hsiang Yu ◽  
Cheng-Ying Shen ◽  
Fang-Ju Sun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Upper Airway ◽  
High Body Mass Index ◽  
Upper Airway Obstruction ◽  
Binary Logistic Regression Model ◽  
Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula. Methods This was a 17-month prospective observational study. For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variable. Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p < 0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938). Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.

Failure of intubation in acute inflammatory airway obstruction in childhood

1985 ◽  
Vol 99 (10) ◽  
pp. 993-998 ◽  
Author(s):  
Peter J. Robb
Keyword(s):  
Airway Obstruction ◽  
Nasotracheal Intubation ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Life Saving ◽  
Life Threatening ◽  
Emergency Tracheotomy

SummaryAt the present time, viral laryngotracheobronchitis. (LTB), and bacterial epiglottitis account for the majority of cases of acute infectious upper airway obstruction in children. This airway obstruction may become life-threatening and require relief either by tracheotomy or by nasotracheal intubation. Recently the trend has been away from tracheotomy and towards intubation. Three cases are reported in this paper, in which intubation by experienced anaesthetists proved impossible, and a life-saving tracheotomy was immediately performed by the otolaryngologist in attondance.It is recommended that an experienced otolaryngologist should always be present at the time of intubation, should it prove impossible, and the child require emergency tracheotomy to secure the airway.

Predictors of difficult endotracheal intubation in the emergency department: a single-center pilot study

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Tracheal Intubation ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Upper Airway ◽  
Difficult Tracheal Intubation ◽  
Upper Airway Obstruction ◽  
Cutoff Score ◽  
Difficult Endotracheal Intubation

Background: Identifying patients who are at risk of difficult endotracheal intubation is crucial in the emergency department. Therefore, this study evaluated the incidence and predictive factors of difficult tracheal intubation in the emergency department. Methods: This was a 17-month prospective observational study. A difficult airway was defined as Cormack & Lehane classification grades III and IV at the first attempt of intubation. Patients who visited the emergency department, underwent traditional endotracheal intubation from participating physicians, and provided informed consent by themselves or via their delegates were enrolled in this study. Univariate associations between patient characteristics and difficult endotracheal intubation were identified, and statistically significant factors were included in a multivariate binary logistic regression model. A generalized association plot was used to show the relationships between variables. Results: A total of 110 patients were enrolled in the study. The incidence of difficult intubation was 35.5% (39/110). In the difficult airway group, significantly higher body mass index (BMI), and incidence of double chin, thick short neck, Mallampati difficulty, small interincisor distance, small thyromental distance, and upper airway obstruction were noted on univariate analysis. A predictive formula for difficult tracheal intubation was successfully established by the combination of four independent predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cutoff score of four maximized Youden’s index, providing sensitivity (79.5%) and specificity (81.7%) (95% CI: 0.794 to 0.938). Conclusions: We used four predictors of difficult tracheal intubation, namely, BMI, thyromental distance, upper airway obstruction, and Mallampati difficulty, to create a predictive formula. This formula could help emergency physicians to quickly identify and carefully manage patients with difficult endotracheal intubation and consult experts early if necessary.

scholarly journals A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

2020 ◽  
Author(s):  
En-Chih Liao ◽  
Wen-Han Chang ◽  
Ching-Hsiang Yu ◽  
Cheng-Ying Shen ◽  
Fang-Ju Sun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Airway Obstruction ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Upper Airway ◽  
High Body Mass Index ◽  
Upper Airway Obstruction ◽  
Binary Logistic Regression Model ◽  
Difficult Endotracheal Intubation

Abstract Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula.Methods For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variables.Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p<0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR]=1.270), thyromental distance (OR=0.614), upper airway obstruction (OR=4.038), and Mallampati difficulty (OR=5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938).Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.Trial registration This 17-month (2011/11/1-2013/3/31) prospective observational study was approved by the Institutional Review Board of MacKay Memorial Hospital (11MMHISO64).

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