Advanced airway adjuncts: Difference between revisions

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*[[Pediatric jet ventilation]]
*[[Pediatric jet ventilation]]


 
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''Airway Adjunct'''
| align="center" style="background:#f0f0f0;"|'''Pros'''
| align="center" style="background:#f0f0f0;"|'''Cons'''
| align="center" style="background:#f0f0f0;"|'''Comments'''
|-
| 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>||||
|-
| Lighted Optical Stylets||High success rate - especially good for trauma, c-spine precautions||Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience||
|-
| ||Use for both reg and nasotrach||||
|-
| ||Lower complication rate||||
|-
| Supraglottic airway||||||
|-
| [[Laryngeal mask airway]]||||||
|-
| Combitube- esoph obturator||Good for nurses and paramedics with limited intubation skill||Large size predisposes to esophogeal dilatation and laceration as a complication||
|-
| ||Indicated if difficult airway predicted: cannot see glottis with laryngoscope||||
|-
| ||Reduced risk for aspiration compared to face mask or LMA||||
|-
| ||Can maintain spinal immobilization||||
|-
| Percutaneous transtracheal ventilation||Prefered over crithyrotomy in children up to age 10-12||Can retain CO2||
|-
| ||Oxygenates well||May cause pneumothorax or barotrauma||
|-
| ||Can use for 30-45 min
|}
===Endotracheal tube introducer (ETI)/Gum Elastic Bougie===
===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>
*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>

Revision as of 11:55, 2 February 2019

Airway Adjunct Pros Cons Comments
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 Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
Use for both reg and nasotrach
Lower complication rate
Supraglottic airway
Laryngeal mask airway
Combitube- esoph obturator Good for nurses and paramedics with limited intubation skill Large size predisposes to esophogeal dilatation and laceration as a complication
Indicated if difficult airway predicted: cannot see glottis with laryngoscope
Reduced risk for aspiration compared to face mask or LMA
Can maintain spinal immobilization
Percutaneous transtracheal ventilation Prefered over crithyrotomy in children up to age 10-12 Can retain CO2
Oxygenates well May cause pneumothorax or barotrauma
Can use for 30-45 min

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 [2]
  • 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[3]
    • 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. ↑ 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.
  3. ↑ 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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