Advanced airway adjuncts
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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 [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
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
- ↑ 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.
- ↑ 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
- ↑ 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
- ↑ 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.