Advanced airway adjuncts: Difference between revisions

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||Large size predisposes to esophogeal dilatation and laceration as a complication
||Large size predisposes to esophogeal dilatation and laceration as a complication
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| Percutaneous transtracheal ventilation
| [[Percutaneous transtracheal ventilation]]
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*Prefered over crithyrotomy in children up to age 10-12  
*Prefered over crithyrotomy in children up to age 10-12  
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*Can retain CO2 *May cause pneumothorax or barotrauma
*Can retain CO2 *May cause pneumothorax or barotrauma
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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>
*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<ref>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.</ref>
**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==
==See Also==

Revision as of 12:57, 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

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.
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