Advanced airway adjuncts: Difference between revisions

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**[[Laryngeal mask airway]]
**[[Laryngeal mask airway]]
*[[Pediatric jet ventilation]]
*[[Pediatric jet ventilation]]
{| {{table}}
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Airway Adjunct'''
| align="center" style="background:#f0f0f0;"|'''Airway Adjunct'''
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| align="center" style="background:#f0f0f0;"|'''Cons'''
| align="center" style="background:#f0f0f0;"|'''Cons'''
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| Endotracheal tube introducer (ETI)/Gum Elastic Bougie||Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not<ref>Driver, B. E., Prekker, M. E., Klein, L. R., Reardon, R. F., Miner, J. R., Fagerstrom, E. T., … Cole, J. B. (2018). Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(21), 2179–2189.</ref>||
| Endotracheal tube introducer (ETI)/Gum Elastic Bougie||Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not [1]||
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| Lighted Optical Stylets||
| Lighted Optical Stylets||*High success rate - especially good for trauma, c-spine precautions *Use for both reg and nasotrach *Lower complication rate||Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
*High success rate - especially good for trauma, c-spine precautions
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*Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
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| ||Use for both reg and nasotrach||
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| ||Lower complication rate||
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| Supraglottic airway||||
| Supraglottic airway||||
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| [[Laryngeal mask airway]]||||
| [[Laryngeal mask airway]]||||
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| Combitube- esoph obturator||Good for nurses and paramedics with limited intubation skill||Large size predisposes to esophogeal dilatation and laceration as a complication
| Combitube- esoph obturator||*Good for nurses and paramedics with limited intubation skill *Indicated if difficult airway predicted: cannot see glottis with laryngoscope *Reduced risk for aspiration compared to face mask or LMA *Can maintain spinal immobilization||Large size predisposes to esophogeal dilatation and laceration as a complication
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| ||Indicated if difficult airway predicted: cannot see glottis with laryngoscope||
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| ||Reduced risk for aspiration compared to face mask or LMA||
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| ||Can maintain spinal immobilization||
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| Percutaneous transtracheal ventilation||Prefered over crithyrotomy in children up to age 10-12||Can retain CO2
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| ||Oxygenates well||May cause pneumothorax or barotrauma
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| ||Can use for 30-45 min
| Percutaneous transtracheal ventilation||*Prefered over crithyrotomy in children up to age 10-12 *Oxygenates well *Can use for 30-45 min||*Can retain CO2 *May cause pneumothorax or barotrauma
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Revision as of 12:26, 2 February 2019

Airway Adjunct Pros Cons
Endotracheal tube introducer (ETI)/Gum Elastic Bougie Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not [1]
Lighted Optical Stylets *High success rate - especially good for trauma, c-spine precautions *Use for both reg and nasotrach *Lower complication rate Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
Supraglottic airway
Laryngeal mask airway
Combitube- esoph obturator *Good for nurses and paramedics with limited intubation skill *Indicated if difficult airway predicted: cannot see glottis with laryngoscope *Reduced risk for aspiration compared to face mask or LMA *Can maintain spinal immobilization Large size predisposes to esophogeal dilatation and laceration as a complication
Percutaneous transtracheal ventilation *Prefered over crithyrotomy in children up to age 10-12 *Oxygenates well *Can use for 30-45 min *Can retain CO2 *May cause pneumothorax or barotrauma

Endotracheal tube introducer (ETI)/Gum Elastic Bougie

  • Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not [1]
  • Blind orotracheal intubation

Lighted Optical Stylets

  • High success rate - especially good for trauma, c-spine precautions
  • Use for both reg and nasotrach
  • Lower complication rate
  • Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience

LMA

Combitube- esoph obturator

  • Good for nurses and paramedics with limited intubation skill
  • Indicated if difficult airway predicted: cannot see glottis with laryngoscope
  • Reduced risk for aspiration compared to face mask or LMA
  • Can maintain spinal immobilization
  • Large size predisposes to esophogeal dilatation and laceration as a complication

Percutaneous transtracheal ventilation

  • PTV
  • Prefered over crithyrotomy in children up to age 10-12
  • Needle, 16-18ga through cricoid membrane, connected to 50 psi 02[2]
    • Oxygenates well
    • Ventilate through glottis and upper airway - can retain CO2
  • Need adequate oxygen pressure
  • 1 sec insp and 2- 3 sec exp to avoid breath stacking
  • Can use for 30-45 min
  • May cause pneumothorax or barotrauma
  • Contraindications
    • Distorted anatomy
    • Bleeding diathesis
    • Complete airway obstruction

See Also

Airway Pages

  1. ↑ Driver, B. E., Prekker, M. E., Klein, L. R., Reardon, R. F., Miner, J. R., Fagerstrom, E. T., … Cole, J. B. (2018). Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(21), 2179–2189.
  2. ↑ Beck, E., Kharasch, M., Casey, J., Ochoa, P., Menon, S., Calabrese, N. and Wang, E. (2011) ‘Percutaneous Transtracheal jet ventilation’, Academic Emergency Medicine, 18(5), pp. e38–e38.
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