Advanced airway adjuncts: Difference between revisions

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*[[Intubation]]
==Advanced Airway Adjuncts==
*[[Surgical cricothyrotomy]]
[[File:PMC4530924 wjem-16-588-g002.png|thumb|Emergency intubator demonstrating preloaded [[bougie]] technique on a mannequin.]]
*[[Supraglottic airway]]
[[File:Masques laryngés- LMA Unique et I-gel.jpg|thumb|Two example [[LMA]] airways.]]
**[[Laryngeal mask airway]]
[[File:Barrel-connector.png|thumb|[[Pediatric jet ventilation]] setup.]]
*[[Pediatric jet ventilation]]
{{Advanced Airway Adjuncts Chart}}
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Airway Adjunct'''
| align="center" style="background:#f0f0f0;"|'''Pros'''
| align="center" style="background:#f0f0f0;"|'''Cons'''
|-
| Endotracheal tube introducer (e.g. 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>
||
|-
| 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]] (e.g. LMA)||||
|-
| Combitube (i.e. 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==
==See Also==
*[[Airway sizes (peds)]]
{{Related Difficult Airway Pages}}


{{Related Difficult Airway Pages}}
==References==


[[Category:Critical Care]]
[[Category:Critical Care]]
[[Category:Procedures]]
[[Category:Procedures]]

Latest revision as of 18:28, 5 March 2025

Advanced Airway Adjuncts

Emergency intubator demonstrating preloaded bougie technique on a mannequin.
Two example LMA airways.
Pediatric jet ventilation setup.

Advanced Airway Adjuncts Chart

Airway Adjunct Examples Pros Cons
Endotracheal tube introducer 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]
  • Can pass blind and confirm tracheal placement with tracheal clicks and hold-up sign
  • Success rates likely depend on operator familiarity with device
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 LMA
  • Easy to place
  • Can be placed quickly
  • Does not protect against aspiration
Esophogeal obturator Combitube
  • 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
Pediatric jet ventilation
  • Prefered over cricothyrotomy 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

References

  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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