Awake tracheal intubation for blunt airway trauma

Milne, Brian; Kandasamy, Gomathy

doi:10.1002/anr3.12012

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…Increase in subcutaneous emphysema and/or persistent pneumothorax despite chest drainage should alert physicians for TBI. [ 9 – 13 ] Here, we report a case of blunt trauma following high-velocity road traffic accident, in whom we noticed “failed airway” which turned out to be due to complete tracheal transection. This case was suspected for airway injury at first evaluation in which the main problem was inadequate ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…In our ED, first FOB performed by staff anesthesiologist was inconclusive and CT scan had showed signs of tracheal rupture. CT scan detect about 90% of TBI by showing abnormal air images around the injured airway, or by directly giving clues for defects in bronchial lumen[ 10 – 13 ] (displacement, blockage, etc.). Prokakis et al[ 5 ] asserted that CT was highly diagnostic for laryngeal traumas, but less specific for TBI.…”

Section: Discussionmentioning

confidence: 99%

“…While awake fiber-optic intubation can be an alternative or assist in tracheostomy in patients with airway injury who are hemodynamically stable and not in respiratory distress. [ 13 , 16 , 17 ]…”

Section: Discussionmentioning

confidence: 99%

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Airway Management of Major Blunt Tracheal and Esophageal Injury: A Case Report

İlhan¹

2020

Ulus Travma Acil Cerrahi Derg

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Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesiologists to deal with. About 25% of post-traumatic deaths are due to thoracic traumas in which blunt injuries take a rather small place within and the resultant damage of respiratory tract is quite rare with an incidence of 0.5–2%. A recent review from a single trauma center revealed an incidence of 0.4% for tracheobronchial injury (TBI) due to blunt thoracic injuries. Most of the patients having tracheal transection lose their lives on the field due to loss of airway. Patients mostly present with a large spectrum of clinical features varying from hoarseness to respiratory collapse; though subcutaneous emphysema is the most common presenting sign which should remind possible TBI. Emergent surgery is preferred seldomly; such in cases of partial damage or because of late diagnosis, due to favorable outcome of conservative approach. Herein, we report the management of a case on TBI due to blunt thoracic trauma, experiencing difficult ventilation despite tracheal intubation. Fiber-optic bronchoscope (FOB) seems obligatory to visualize site and severity of injury and to ensure safe airway during procedures such as the neck exploration, primary end-to-end anastomosis of the trachea, tracheostomy, diversion pharyngostomy, and feeding jejunostomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Airway Management of Major Blunt Tracheal and Esophageal Injury: A Case Report

İlhan¹

2020

Ulus Travma Acil Cerrahi Derg

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“…Milne et al. provide a detailed description of their decision‐making, as well as the relevant evidence, for how best to secure the airway of a patient with a laryngeal fracture and worsening laryngeal oedema following blunt neck trauma . The associated discussion highlights how the principles of advanced airway management, such as awake tracheal intubation (ATI), are best taught and discussed when dissociated from general anaesthesia.…”

Section: Airway Managementmentioning

confidence: 99%

Reports in anaesthesia come of age!

Dalay

Guris

Shelton³

et al. 2019

Anaesthesia Reports

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In March 2019, Anaesthesia Reports, known previously as Anaesthesia Cases, launched with the publication of five new case reports. As a new online-only journal, we have implemented a continuous publication model where new reports appear online shortly following acceptance and are included in an issue. This allows rapid publication as soon as an article has been peer reviewed, revised, accepted, edited and typeset. We publish two issues each year, and our first issue includes 17 excellent new reports. Each report serves some novelty, educational value or interest to our readership. In this editorial we highlight the key clinical learning points from the first issue of the new Anaesthesia Reports format, which is the seventh issue since the inception of Anaesthesia Cases. Airway managementAwake nasal intubation with a flexible bronchoscope remains a safe procedure with a high success rate [1]. However, nasal tracheal tubes may not be the best option for mechanical ventilation in critical care and there may be several indications for a tracheal tube exchange procedure. Saunders et al. are the first to describe a novel approach to videolaryngoscope-assisted flexible intubation tracheal tube exchange, which, using a combination of several simple techniques, ensures the airway remains secure and visible throughout [2]. They provide an excellent recipe to navigate this challenging scenario which will be of use to all clinicians. Apnoeic oxygenation was first described in 1667, but only now are we beginning to understand its underlying physiology and clinical applications [3]. This has probably increased our familiarity with high-flow nasal oxygen, which is increasingly used for self-ventilating patients in several settings. Sodha and Fernandez are the first to describe its use in combination with deep intravenous sedation for a patient with obstructive sleep apnoea requiring surgery in the prone position [4]. As well as sparking significant debate among our readership, some commented that they have seen similar techniques used in past [5] which emphasises that case reports are worth writing. If your case is novel, educational and interesting, we will consider publishing it.Milne et al. provide a detailed description of their decision-making, as well as the relevant evidence, for how best to secure the airway of a patient with a laryngeal fracture and worsening laryngeal oedema following blunt neck trauma [6]. The associated discussion highlights how the principles of advanced airway management, such as awake tracheal intubation (ATI), are best taught and discussed when dissociated from general anaesthesia. Finally, the debate about the best technique for ATI continues, and the new Difficult Airway Society ATI guidelines are eagerly anticipated [7,8].

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