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Circulation Jan 2024This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison... (Review)
Review
2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.
Topics: Infant; Child; Infant, Newborn; Humans; United States; Resuscitation; American Heart Association; Cardiopulmonary Resuscitation; Emergency Medical Services; Emergency Treatment
PubMed: 37970724
DOI: 10.1161/CIR.0000000000001181 -
Seminars in Fetal & Neonatal Medicine Oct 2023Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in... (Review)
Review
Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in intubation, alternative strategies are critical. Most preterm infants breathe spontaneously, and require stabilisation rather than resuscitation at birth. Use of tactile stimulation, deferred cord clamping, and avoidance of hypoxia can help optimise breathing for these infants. Nasal devices appear a promising alternative to the face mask for early provision of respiratory support. In term and near-term infants, supraglottic airways may be the most effective initial approach to resuscitation. Use of supraglottic airways during resuscitation can be taught to a range of providers, and may reduce need for intubation. While face mask ventilation is an important skill, it is challenging to perform effectively. Identification of the best approach to training the use of these devices during neonatal resuscitation remains an important priority.
Topics: Infant; Infant, Newborn; Humans; Intubation, Intratracheal; Infant, Premature; Resuscitation; Masks; Respiration
PubMed: 38000926
DOI: 10.1016/j.siny.2023.101488 -
Clinical and Experimental Pediatrics May 2024
PubMed: 38186260
DOI: 10.3345/cep.2023.01200 -
Healthcare (Basel, Switzerland) Sep 2023A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All... (Review)
Review
A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.
PubMed: 37761667
DOI: 10.3390/healthcare11182468 -
Cureus Dec 2023Apneic oxygenation is a technique used during airway management procedures to maintain oxygenation and prevent desaturation during a lack of ventilation. Despite its... (Review)
Review
Apneic oxygenation is a technique used during airway management procedures to maintain oxygenation and prevent desaturation during a lack of ventilation. Despite its importance, there is a lack of comprehensive information on how to achieve effective apneic oxygenation, leading to misunderstandings and suboptimal utilization of this technique. Apneic oxygenation involves several key steps. Firstly, patient selection is crucial, considering factors such as anticipated difficulty with airway management, reduced functional residual capacity, increased oxygen consumption, and medical conditions associated with impaired oxygenation. Secondly, adequate preoxygenation is essential to optimize oxygen reserves before the onset of apnea, utilizing methods like non-rebreather oxygen masks or specific breathing techniques. Thirdly, maintaining airway patency through techniques such as jaw thrust or nasopharyngeal airway placement allows for unobstructed airflow during the apneic period. Lastly, the selection of the appropriate oxygen delivery method, such as high-flow nasal oxygen or nasal cannula, depends on the patient's existing respiratory support. Despite the growing body of literature on apneic oxygenation, current review articles often lack a stepwise approach for its proper execution. This knowledge gap contributes to the misunderstanding and underutilization of this important tool during intubation and airway management. In conclusion, apneic oxygenation is a valuable technique for maintaining oxygenation during periods of apnea. However, the lack of comprehensive information and stepwise guidance in the current literature hinders its optimal utilization. Clear guidelines and educational resources should be developed to address this knowledge gap and ensure the safe and effective implementation of apneic oxygenation. By following a stepwise approach that includes patient selection, adequate preoxygenation, airway patency, and appropriate oxygen delivery, healthcare providers can enhance patient outcomes and minimize the risk of desaturation during airway management procedures.
PubMed: 38249244
DOI: 10.7759/cureus.50916 -
Clinical and Experimental Pediatrics May 2024Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a...
Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation. Furthermore, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation. In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods. Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway). In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers. Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.
PubMed: 37448129
DOI: 10.3345/cep.2023.00619 -
Medicine Dec 2023Some laryngeal masses are typically asymptomatic and easily ignored. However, they can be rare causes of unanticipated difficult airway, leading to critical situations... (Review)
Review
RATIONALE
Some laryngeal masses are typically asymptomatic and easily ignored. However, they can be rare causes of unanticipated difficult airway, leading to critical situations such as "cannot ventilate" or "cannot ventilate and cannot intubate" during anesthesia induction. Inappropriate airway management in such scenarios can have catastrophic consequences for an anesthetized patient. Here we report a case of sudden, unanticipated difficult mask ventilation caused by an asymptomatic supraglottic mass during sedative induction, which was quickly and effectively relieved by the Heimlich maneuver and chest compression.
PATIENT CONCERNS
We report a rare case of airway crisis occurred during sedative induction in a 63-year-old patient scheduled for a routine flexible bronchoscopy, and no evidence of respiratory difficulty or signs of obstruction was found in preoperative evaluation.
DIAGNOSES
A detailed examination of laryngopharyngeal structure under bronchoscopy revealed a supraglottic soft-tissue mass with a size of 1.6 × 0.8 cm covering the membranous part of the glottic area, which was the true cause of difficult mask ventilation in this patient during sedative induction.
INTERVENTIONS
As the unanticipated difficult mask ventilation occurred, 2-handed mask ventilation was initiated immediately for 9 attempts but failed. Fortunately, the airway crisis was successfully relieved with 2 Heimlich attempts and 3 chest compressions, and no need for a laryngeal mask airway.
OUTCOMES
Once the airway crisis was relieved and the supraglottic mass was confirmed, the patient underwent a second sedative anesthesia and a successful laryngeal mask airway-assisted bronchoscopy, with no post-bronchoscopy adverse events.
LESSONS
Asymptomatic supraglottic masses can cause valve-like upper airway obstruction and lead to unanticipated difficult mask ventilation. The Heimlich maneuver and chest compression may be effective in such critical situations and can serve as an emergency intervention.
Topics: Humans; Middle Aged; Intubation, Intratracheal; Heimlich Maneuver; Laryngeal Masks; Anesthesia, General; Hypnotics and Sedatives
PubMed: 38050299
DOI: 10.1097/MD.0000000000036362 -
BMC Anesthesiology Nov 2023To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery.
METHODS
Children aged 3-7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators.
RESULTS
The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05).
CONCLUSION
Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn't encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management.
TRIAL REGISTRATION
The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. ( https://www.chictr.org.cn . Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).
Topics: Humans; Child; Laryngeal Masks; Ambulatory Surgical Procedures; Retrospective Studies; Lung; Pulmonary Atelectasis; Postoperative Complications
PubMed: 37932735
DOI: 10.1186/s12871-023-02327-2 -
Nan Fang Yi Ke Da Xue Xue Bao = Journal... Sep 2023To explore the effect of THRIVE combined with i-gel laryngeal mask on the safety of oxygen therapy in apnea and surgical precision of retrograde intrarenal surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To explore the effect of THRIVE combined with i-gel laryngeal mask on the safety of oxygen therapy in apnea and surgical precision of retrograde intrarenal surgery.
METHODS
A total of 120 patients undergoing retrograde intrarenal surgery under general anesthesia with laryngeal mask were randomized into 3 groups (=40), and after the flexible ureteroscope entered the renal pelvis and located the stones, the patients received assisted ventilation in APPV mode (control group), ventilation with small tidal volume and high respiratory rate (group H), or THRIVE combined with laryngeal mask for oxygen supply without using the ventilator (THRIVE group). The time for lithotripsy by the surgeons, surgeons' satisfaction, diaphragm mobility, and times of urinary tract mucosal injury were recorded, and arterial blood pressure, heart rate, SpO, PaO, PaCO, and pH value were measured before, during and after lithotripsy.
RESULTS
Among the 3 groups, THRIVE group had the shortest time for lithotripsy, best satisfaction of the surgeons, the lowest diaphragmatic mobility of the patients, and the smallest number of mucosal injuries. The arterial blood pressure, heart rate, and SpO of the patients did not differ significantly among the 3 groups. At 20 min and 30 min after the start of lithotripsy, PaO decreased significantly in group H and THRIVE group; in THRIVE group, PaCO increased and pH decreased significantly at 10, 20 and 30 min after the start of lithotripsy. No significant difference was found in oxygenation indicators among the 3 groups upon discharge from the PACU.
CONCLUSION
In retrograde intrarenal surgery, THRIVE combined with i- gel laryngeal mask for oxygen therapy during the anaerobic period can improve the surgical accuracy and maintain the patient's oxygenation index in a controllable range within 30 min.
Topics: Humans; Respiration, Artificial; Laryngeal Masks; Insufflation; Administration, Intranasal; Oxygen
PubMed: 37814875
DOI: 10.12122/j.issn.1673-4254.2023.09.18