Advanced airway adjuncts: Difference between revisions

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| align="center" style="background:#f0f0f0;"|'''Airway Adjunct'''
| align="center" style="background:#f0f0f0;"|'''Airway Adjunct'''
| align="center" style="background:#f0f0f0;"|'''Eamples'''
| align="center" style="background:#f0f0f0;"|'''Pros'''
| align="center" style="background:#f0f0f0;"|'''Pros'''
| align="center" style="background:#f0f0f0;"|'''Cons'''
| align="center" style="background:#f0f0f0;"|'''Cons'''
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| Endotracheal tube introducer (e.g. gum elastic bougie)||
| Endotracheal tube introducer (e.g. gum elastic bougie)|| gum elastic bougie
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*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>
*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>
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| Lighted optical stylets||
| Lighted optical stylets||
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*High success rate - especially good for trauma, c-spine precautions *Use for both reg and nasotrach  
*High success rate - especially good for trauma, c-spine precautions *Use for both reg and nasotrach  
*Lower complication rate
*Lower complication rate
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*Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
*Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
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| [[Supraglottic airway]] (e.g. LMA)||||
| [[Supraglottic airway]]||LMA
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| Combitube (i.e. esoph obturator)||
| Combitube||esoph obturator
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*Good for nurses and paramedics with limited intubation skill  
*Good for nurses and paramedics with limited intubation skill  
*Indicated if difficult airway predicted: cannot see glottis with laryngoscope  
*Indicated if difficult airway predicted: cannot see glottis with laryngoscope  
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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  

Revision as of 13:03, 2 February 2019

Airway Adjunct Eamples Pros Cons
Endotracheal tube introducer (e.g. gum elastic bougie) 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 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
  • 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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