Airway Rescue with the ProSeal™ Laryngeal Mask Airway in the Intensive Care Unit

Abstract

We report the successful use of the ProSeal™ laryngeal mask airway for airway rescue in a 41-year-old septic patient who could be neither intubated nor facemask ventilated. In principle, the ProSeal™ laryngeal mask airway offers advantages over the Classic LMA in this situation.

Comparative evaluation of gum-elastic bougie and introducer tool as aids in positioning of ProSeal laryngeal mask airway in patients with simulated restricted neck mobility

“…It has been successfully placed even in obese patients either in anaesthetic or critical care situations. [7891011] There are various described techniques of insertion of PLMA. [12] Guided insertion was more frequently successful than the digital and IT techniques in patients with simulated difficult airway with a rigid neck collar.…”

Airway rescue in acute upper airway obstruction using a ProSeal™ Laryngeal mask airway and an Aintree Catheter™: a review of the ProSeal™ Laryngeal mask airway in the management of the difficult airway

“…There are a further 10 reports of airway rescue with the PLMA after failed intubation and/or failed ventilation (Table 2) [39–47]. In most cases these were extreme emergencies with progressive hypoxaemia.…”

“…In most cases these were extreme emergencies with progressive hypoxaemia. In all, there are four cases when the PLMA achieved airway rescue after ‘routine intubation’[38–41], and seven after rapid sequence induction (RSI) [42–47].…”

“…Of the ‘routine intubations’, two occurred on the intensive care unit [39, 40] and one was associated with impossible face‐mask ventilation [40]. In one case, control of the airway was followed by immediate tracheostomy [39] and in the other the trachea was intubated with a size 6.0 mm id tracheal tube, with fibreoptic guidance, through the PLMA before proceeding to tracheostomy [40].…”

Which is the logical supraglottic airway device for use on ICU?

“…Of note Dr Koracev refers to a trial where a laryngeal mask airway was used to deliver continuous positive airway pressure (CPAP); this was, in fact, the PLMA [5]. The PLMA has been used on ICU throughout a brief (8 h) period of ventilation [6] and for airway rescue following inadvertent extubation. On our ICU we have used it for managing a difficult airway and initiating ventilation, as a bridge to extubation during problematic weaning from ventilation and for bronchoscope‐guided percutaneous tracheostomy.…”