Failed Intubation in the Intensive Care Unit Managed with Laryngeal Mask Airway and Percutaneous Tracheostomy

Divatia, JV; Kulkarni, AP; Sindhkar, S; Sm, Upadhye

doi:10.1177/0310057x9902700414

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…Several measures were integrated into the procedure to decrease the likelihood of this occurrence: first, the ETT was not manipulated until the patient was prepped and draped; second, the ETT tube ties were loosened only after insertion of the bronchoscope; third, the ETT tube and bronchoscope were held and withdrawn only by a physician; and fourth, the ETT and bronchoscope were withdrawn slowly, looking externally for wound transillumination and internally for tracheal wall compression with a finger or mosquito forceps. The use of the LMA for percutaneous tracheotomy has been proposed as a means of avoiding accidental extubation 149–152 while still allowing endoscopic visualization. In this series, the LMA was used with ease in six patients with soiled ETTs requiring tube changes prior to tracheotomy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Percutaneous Dilatational Tracheotomy: A Prospective Evaluation of 500 Consecutive Cases

2005

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Endoscopic PDT is associated with a low complication rate and is at least as safe as surgical tracheotomy in the ICU setting. Bronchoscopy significantly decreases the incidence of complications and should be used routinely. While embraced by critical care physicians, endoscopic PDT has been infrequently performed by otolaryngologists. As the airway experts, otolaryngologists are in the best position to learn and teach the procedure as it should be done.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Percutaneous Dilatational Tracheotomy: A Prospective Evaluation of 500 Consecutive Cases

2005

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“…44 Oxygenation attempts should be continued by nasal oxygen, SGA, or facemask during the transition and whilst performing FONA. 1,6,9,10,210 Ensure adequate neuromuscular blockade: this increases success of FONA (and other airway rescue techniques). 9,10 If sugammadex has been administered earlier, a second NMBA other than rocuronium or vecuronium is indicated.…”

Section: Transition To Fonamentioning

confidence: 99%

Guidelines for the management of tracheal intubation in critically ill adults

Higgs

McGrath²,

Goddard

et al. 2018

British Journal of Anaesthesia

646

521

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These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4 National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.

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“…[22] Incorporation of supraglottic device early for oxygenation and definitive airway followed by surgical or percutanous tracheostomy in airway management in critically ill patients needs future prospective studies. [2324] Acquiring knowledge and expertise and adherence to defined strategies and algorithms can resolve most problems in airway management in the ICU.…”

Section: Airway Management Algorithm In the Intensive Care Unitmentioning

confidence: 99%

Tracheal intubation in the ICU: Life saving or life threatening?

2011

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Tracheal intubation (TI) is a routine procedure in the intensive care unit (ICU), and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR), the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

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Failed Intubation in the Intensive Care Unit Managed with Laryngeal Mask Airway and Percutaneous Tracheostomy

Cited by 9 publications

References 10 publications

Endoscopic Percutaneous Dilatational Tracheotomy: A Prospective Evaluation of 500 Consecutive Cases

Endoscopic Percutaneous Dilatational Tracheotomy: A Prospective Evaluation of 500 Consecutive Cases

Guidelines for the management of tracheal intubation in critically ill adults

Tracheal intubation in the ICU: Life saving or life threatening?

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