Airway challenges in critical care

Nolan, Jerry P.; Kelly, F. E.

doi:10.1111/j.1365-2044.2011.06937.x

Cited by 121 publications

(80 citation statements)

References 65 publications

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“…ETT exchange may be required to ventilate and oxygenate the patient, a high-risk procedure in an emergency ICU setting. 3 In contrast, partial occlusion due to secretion accumulation is ubiquitous and recklessly ignored, with an average estimated loss of intraluminal ETT volume of between 9 and 15%. 4,5 Occlusion increases the air-flow resistance within the ETT, thereby imposing additional work of breathing on critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Removal of Endotracheal Tube Obstruction With a Secretion Clearance Device

Mietto

Foley²,

Salerno³

et al. 2013

Respir Care

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Accumulation of secretions may suddenly occlude an endotracheal tube (ETT), requiring immediate medical attention. The endOclear catheter (Endoclear LLC, Petoskey, Michigan) is a novel device designed to clear mucus and debris from an ETT and restore luminal patency. We present 3 subsequent cases of life-threatening partial ETT occlusions recorded over a period of 6 months at Massachusetts General Hospital. After conventional methods (standard tracheal suctioning and bronchoscopy) failed, the endOclear was used, with successful restoration of the airways in all 3 cases. The respiratory conditions rapidly improved, and all 3 patients tolerated the ETT-cleaning maneuver. These results show that such a device is safe and easy to use during an emergency airway situation for efficient and rapid removal of secretions from obstructed ETTs by respiratory therapists.

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Section: Introductionmentioning

confidence: 99%

Removal of Endotracheal Tube Obstruction With a Secretion Clearance Device

Mietto

Foley²,

Salerno³

et al. 2013

Respir Care

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“…La intubación traqueal en el paciente crítico imprime diversos tipos de exigencias al equipo tratante: de tiempo por la urgencia, de competencias técnicas y no-técnicas, estrategias avanzadas, de trabajo en equipo y también derivado de la inestabilidad característica del paciente crítico 1,2,3 . Por esto es fácil comprender que la intubación de urgencia sea uno de los procedimientos con mayor riesgo en el manejo de estos pacientes y que se recomienden estrategias para mejorar su eficacia 4,5 .…”

Section: Discussionunclassified

Vía aérea “fisiológicamente” difícil: nuevo concepto a considerar – Caso clínico vía aérea difícil fisiológica

V.¹,

G.²,

P.³

et al. 2017

Rev Chil Anest

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Airway management in the ICU scenario is a real challenge due to instability imposed by illness severity. Some of these patients may also suffer from other diseases associated to difficult airway. Rheumatoid arthritis represents a special condition because not only can limit access to the hypopharynx, but also can hamper laryngoscopy. Among many options for difficult airway management, only a few can be safely applied to intubate the trachea while preserving physiologic stability in an emergency setting. We chose awake fiberoptic intubation as the first and safest approach for this combined difficult patient. This approach requires not only individual skills but also a plan in advance and a well coordinated team to be successful. A case is presented as an example of difficulties imposed by physiologic instability added to anatomic difficult. RESUMENEl manejo de la vía aérea en la UCI representa un desafío debido a la inestabilidad derivada de la severidad de la patología. Además, algunos de estos pacientes pueden presentar condiciones preexistentes asociadas a vía aérea difícil. La artritis reumatoide representa una condición especial debido a que no sólo limita el acceso a la hipofaringe, sino que también puede dificultar la laringoscopía. Entre las diferentes opciones para manejar la vía aérea, sólo algunas pueden ser aplicadas para intubar la tráquea de manera segura y al mismo tiempo preservar la estabilidad fisiológica en un contexto de urgencia. Este abordaje requiere no sólo habilidades individuales, sino que también trabajo en equipo coordinado y planificación. Se presenta un caso como ejemplo de dificultades impuestas por la inestabilidad fisiológica agregada a dificultad anatómica.

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“…To prevent damage and to promote patient safety, planning structures and work processes must be designed and redesigned, as ignorance and lack of protocols are common causes of human error (9) . These instruments are effective barriers to the occurrence of errors, or minimizing their likelihood, and the risk of harm to the patient (2) .…”

Section: Discussionmentioning

confidence: 99%

“…However, most incident injuries are tracheomalacia, tracheal necrosis and stenosis, laryngeal and vocal cords ulcers, paresis and paralysis of vocal cords, tracheoesophageal fistula and granuloma, all related to the greater length of time device use (3,(6)(7)(8) . Furthermore, the intubation procedure can lead to complications in clinical status of patients, including: severe hypoxia, severe hypotension, esophageal intubation, aspiration, cardiac arrest and death (9) . Regarding the lesions caused by the use of tracheostomy, these may occur in the intraoperative period, with unilaterally or bilaterally laryngeal nerve injury; esophageal injury with tracheoesophageal fistula; and early lesions in the first six days with false path by moving the tracheal tube.…”

Section: Introductionmentioning

confidence: 99%

Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices

Pinto

Schons

Busanello

et al. 2015

Rev. esc. enferm. USP

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Objective:To analyze the care implemented by the nursing team to promote the safety of adult patients and prevention of skin and mucosal lesions associated with the presence of lower airways invasive devices. Method: Study with qualitative and quantitative approach, descriptive and exploratory type, whose investigative scenarios were adult inpatient units of a hospital in the West Frontier of Rio Grande do Sul. The study subjects consisted of nurses, nursing technicians and nursing assistants. Results: A total of 118 professionals were interviewed. We highlight the observed specific care with endotracheal tube and tracheostomy, management and assessment of the cuff and the criteria used to secretion aspiration. Conclusion: There is a superficial nursing work in the patient direct care and a differentiation in relation to the perception of nurse technicians, especially those working in the intensive care unit, who presented major property and view of the patient's clinical status. DESCRIPTORS Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devicesSegurança do paciente e a prevenção de lesões cutâneo-mucosas associadas aos dispositivos invasivos nas vias aéreas La seguridad del paciente y la prevención de lesiones cutáneo-mucosas asociadas con los dispositivos invasivos en las vías aéreas INTRODUCTIONHospitalized patients in clinical units or intensive care units at some point may require the use of an airway device to replace or assist in maintaining ventilation. The use of an endotracheal tube (ET) and/or tracheostomy tube are the main instruments that composes this maintenance, allowing oxygen installation, removal of secretions and mechanical ventilation.Facing the use of these invasive devices, patients can be subjected to cutaneous and mucosal lesions in upper and lower airways. Thus, we highlight aspects related to patient safety and the onset of these adverse events that may result from the length of use, above all, the list of complex care required to maintain these devices, in which minimum failures can be translated in irreparable damage to the patient.Patient safety is aimed at reducing unnecessary harm, involving the practical actions that minimize the complications to the context and devices from which care is provided (1) . Still, patient safety is related to the actions to ensure the integrity of people, preventing adverse events and the prevention of errors, thus promoting a safer patient care (2) . Thus, care processes that permeate the care of patients who use these devices, especially those airways invasive, should focus on reducing the risk of skin and mucosal, oropharyngeal, laryngopharyngeal, laryngeal and tracheal lesions. These measures ensure the airway maintenance, important for therapy, avoiding possible temporary or permanent damage, longer hospitalizations and, consequently, the patient's suffering.Considering the security for the prevention of skin and mucosal lesions in patients undergoing lower airways invasive devices, there...

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Airway challenges in critical care

Cited by 121 publications

References 65 publications

Removal of Endotracheal Tube Obstruction With a Secretion Clearance Device

Removal of Endotracheal Tube Obstruction With a Secretion Clearance Device

Vía aérea “fisiológicamente” difícil: nuevo concepto a considerar – Caso clínico vía aérea difícil fisiológica

Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices

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