-
Anaesthesiology Intensive Therapy 2022Penetrating thoracic trauma accounts for 20-25% of all deaths due to trauma in the first four decades of life. About 33% of deaths from thoracic trauma occur due to... (Review)
Review
Penetrating thoracic trauma accounts for 20-25% of all deaths due to trauma in the first four decades of life. About 33% of deaths from thoracic trauma occur due to penetrating trauma. In an autopsy study that enrolled 1178 trauma patients, 82% of the patients with tracheobronchial injuries died at the incidence site. In another study, 30% of those who could be transferred to the hospital died. This review aimed to revisit penetrating thoracic trauma with respect to complications and the strategies for airway management. While the risk of death in injuries with a sharp object is normally 1-8%, it reaches 25-28% when the cardiac box is included, and still, most of the patients are lost before they can come to the hospital. The consequences and management of penetrating thoracic trauma are mainly dependent on the extent of the injury to internal organs, as well as on the skill of the clinicians, airway obstruction, respiratory failure, and bleeding. Chest computed tomography (CT) is better than chest radiography in diagnosing the main bronchus or lobe/segment rupture. However, with the use of multi-channel multi-detector CT, the sensitivity of CT imaging has increased to 94% in the diagnosis of tracheobronchial injuries. While standard orotracheal intubation is sufficient in 75% of the patients, flexible bronchoscopy, intubation through the open wound or tracheostomy is required for airway provision in the rest. Clinical suspicion is the first diagnostic tool in a patient with penetrating airway trauma, and early treatment with multidisciplinary teamwork is life-saving.
Topics: Bronchoscopy; Humans; Intubation, Intratracheal; Thoracic Injuries; Tracheostomy; Wounds, Penetrating
PubMed: 36000693
DOI: 10.5114/ait.2022.118332 -
Critical Care (London, England) Jun 2020Those involved in the airway management of COVID-19 patients are particularly at risk. Here, we describe a practical, stepwise protocol for safe in-hospital airway... (Review)
Review
Those involved in the airway management of COVID-19 patients are particularly at risk. Here, we describe a practical, stepwise protocol for safe in-hospital airway management in patients with suspected or confirmed COVID-19 infection.
Topics: Airway Management; COVID-19; Coronavirus Infections; Hospitalization; Humans; Pandemics; Pneumonia, Viral
PubMed: 32503600
DOI: 10.1186/s13054-020-03018-x -
Hong Kong Medical Journal = Xianggang... Aug 2022The novel coronavirus disease (COVID-19) may result in acute respiratory distress syndrome and respiratory failure, necessitating mechanical respiratory support....
The novel coronavirus disease (COVID-19) may result in acute respiratory distress syndrome and respiratory failure, necessitating mechanical respiratory support. Healthcare professionals are exposed to a particularly high risk of contracting the virus while providing resuscitation and respiratory support, which may in turn result in grave consequences and even death. Although COVID-19 has been shown to cause milder disease in children, paediatricians and intensivists who provide care for children must be prepared to provide optimal respiratory support without putting themselves or other medical, nursing, and paramedical staff at undue risk. We propose an airway management approach that is especially relevant in the current COVID-19 pandemic and provides instructions for: (1) Elective intubation for respiratory failure; and (2) Emergency intubation during cardiopulmonary resuscitation. To minimise risk, intubation methods must be kept as straightforward as possible and should include the provision of appropriate personal protection and equipment to healthcare workers. We identify two key considerations: that bag-mask ventilation should be avoided if possible and that bacterial and viral filters should be placed in the respiratory circuit. Our novel approach provides a framework for airway management that could benefit paediatric critical care practitioners who provide care for any children with a novel viral illness, with a focus on infection prevention during high-risk airway management procedures.
Topics: Airway Management; COVID-19; Child; Humans; Pandemics; Respiratory Insufficiency; SARS-CoV-2
PubMed: 33750741
DOI: 10.12809/hkmj208709 -
Anaesthesia Mar 2023
Topics: Humans; Airway Management; Ventilators, Mechanical
PubMed: 36205378
DOI: 10.1111/anae.15883 -
Korean Journal of Anesthesiology Dec 2019High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway... (Review)
Review
High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.
Topics: Age Factors; Airway Management; Anesthesia, General; Cannula; Humans; Hypercapnia; Masks; Oxygen Inhalation Therapy; Perioperative Care; Rapid Sequence Induction and Intubation; Respiratory System
PubMed: 31163107
DOI: 10.4097/kja.19174 -
British Journal of Anaesthesia Feb 2022We outline the history, implementation and clinical impact of the formation of an Airway Lead Network. Although recommendations to improve patient safety in airway...
We outline the history, implementation and clinical impact of the formation of an Airway Lead Network. Although recommendations to improve patient safety in airway management are published and revised regularly, uniform implementation of such guidelines are applied sporadically throughout the hospital and prehospital settings. The primary roles of an Airway Lead are to ensure supply, quality and storage of airway equipment, promote the use of current practice guidelines as well as the organisation of training and audits. Locally, the Airway Lead may chair a multi-disciplinary airway committee within their organisation; an Airway Lead Network enables Airway Leads to share common problems and solutions to promote optimal airway management on a national level. Support from governing bodies is an essential part of this structure.
Topics: Airway Management; Hospitals; Humans; Patient Safety; Practice Guidelines as Topic
PubMed: 34893313
DOI: 10.1016/j.bja.2021.11.013 -
Anesthesiology Apr 2020
Topics: Airway Management; Airway Obstruction; Epiglottis; Humans; Hyperostosis, Diffuse Idiopathic Skeletal
PubMed: 31972658
DOI: 10.1097/ALN.0000000000003136 -
Anaesthesia Aug 2020
Topics: Insufflation; Prospective Studies; Respiration, Artificial
PubMed: 32350853
DOI: 10.1111/anae.15066 -
British Journal of Anaesthesia Jul 2020
Topics: Airway Management; Intubation, Intratracheal; Laryngoscopy; Space Flight; Weightlessness
PubMed: 31918846
DOI: 10.1016/j.bja.2019.12.002 -
Respiratory Care Sep 2019The optimization of ventilation during cardiopulmonary resuscitation (CPR) is a broad field of research. Recent physiological observations in this field challenge the... (Review)
Review
The optimization of ventilation during cardiopulmonary resuscitation (CPR) is a broad field of research. Recent physiological observations in this field challenge the current understanding of respiratory and circulatory interactions. Thanks to different models available (bench, animal, human), the understanding of physiological phenomena occurring during CPR has progressed. In this review, we describe the clinical observations that have led to the emerging concept of lung volume reduction and associated thoracic airway closure. We summarize the clinical and animal observations supporting these concepts. We then discuss the different contributions of bench, animal, and human models to the understanding of airway closure and their impact on intrathoracic pressure, airway closure, and hemodynamics generated by chest compression. The limitation of airway pressure and ventilation, resulting from airway closure reproducible in models, may play a major role in ventilation and gas exchange impairment observed during prolonged resuscitation.
Topics: Airway Management; Animals; Cardiopulmonary Resuscitation; Hemodynamics; Humans; Pressure; Respiration; Thorax
PubMed: 31138729
DOI: 10.4187/respcare.06998