Advanced airway adjuncts
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| Airway Adjunct | Pros | Cons |
| 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 *Use for both reg and nasotrach *Lower complication rate | Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience |
| Supraglottic airway | ||
| Laryngeal mask airway | ||
| 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 |
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
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[2]
- 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.
- ↑ 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.