Advanced airway adjuncts: Difference between revisions
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**[[Laryngeal Mask Airway (LMA)]]
**[[Laryngeal Mask Airway (LMA)]]
*[[Pediatric jet ventilation]]
*[[Pediatric jet ventilation]]
===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]]===
*Can use without muscle relaxants
*Better than face mask
*Can be used as bridge to fiberoptic intubation
*Limited by unreliable seal at peak insp pressure
*Aspiration risk
*Mucosal trauma
*LMA better than endotracheal for paramedics, especially in pediatric patients<ref>Zhu X-Y, Lin B-C, Zhang Q-S, Ye H-M, Yu R-J. A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation. 2011;82(11):1405–1409. doi:10.1016/j.resuscitation.2011.06.010</ref><ref>Calkins MD, Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma. 1999;46(5):927–932</ref>
*Intubating LMA (LMA-Fastrach) provides the opportunity to convert to a definitive airway after rescue with the supraglottic device
===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 11:44, 2 February 2019


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

  • Can use without muscle relaxants
  • Better than face mask
  • Can be used as bridge to fiberoptic intubation
  • Limited by unreliable seal at peak insp pressure
  • Aspiration risk
  • Mucosal trauma
  • LMA better than endotracheal for paramedics, especially in pediatric patients[2][3]
  • Intubating LMA (LMA-Fastrach) provides the opportunity to convert to a definitive airway after rescue with the supraglottic device

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[4]
    • 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. ↑ Zhu X-Y, Lin B-C, Zhang Q-S, Ye H-M, Yu R-J. A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation. 2011;82(11):1405–1409. doi:10.1016/j.resuscitation.2011.06.010
  3. ↑ Calkins MD, Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma. 1999;46(5):927–932
  4. ↑ 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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