The Physiologically Difficult Airway

Mosier, Jarrod; Joshi, Raj; Hypes, Cameron; Pacheco, Garrett S.; Valenzuela, Terence D.; Sakles, John C.

doi:10.5811/westjem.2015.8.27467

Cited by 178 publications

(182 citation statements)

References 90 publications

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“…However, patients experiencing arterial desaturation had higher mortality as compared to controls. Not surprising, hypoxemia results in added stress to an already stressed system, which could result in unwanted consequences as illustrated in the literature (35)(36)(37). In addition, it's been shown that proning patients decreases mortality and the major physiologic impact is an increase in their arterial oxygen.…”

Section: Discussionmentioning

confidence: 99%

Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

Smischney¹,

Seisa²,

Heise³

et al. 2017

J. Thorac. Dis.

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Background: Arterial desaturations experienced during endotracheal intubation (ETI) may lead to poor outcomes. Thus, our primary aim was to identify predictors of arterial desaturation (pulse oximetry <90%) during the peri-intubation period and to assess outcomes of those who developed arterial hypoxemia. Conclusions: Patients who were intubated for acute respiratory failure and those who were intubated by junior level trainees had increased odds of experiencing arterial desaturation in the peri-intubation period.Patients experiencing arterial desaturation had lower pulse oximetry readings prior to intubation suggesting a possible delay at intubation.

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Section: Discussionmentioning

confidence: 99%

Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

Smischney¹,

Seisa²,

Heise³

et al. 2017

J. Thorac. Dis.

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“…Critical patient may present, mainly, hypoxemia, severe metabolic acidosis, hypotension, and right ventricular insufficiency [9,16,19,20], with a degree of hemodynamic instability resulting in a low cardiopulmonary reserve, in addition to a full stomach, etc., and the implementation of a package of measures for intubation can reduce the incidence of life-threatening complications from 32 to 17% (p = 0.01) during intubation (biblioUCI46). This package of measures should consist of 10 key points ( Table 2).…”

Section: Post-intubationmentioning

confidence: 99%

“…Although there is insufficient evidence, adrenaline diluted at a concentration of 1-10 mcg mL −1 , to be administered in boluses of 10-50 mcg, may be most indicated because of its inotropic effect [16,109,110,113,114].…”

Section: Hypotensionmentioning

confidence: 99%

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Videolaryngoscopy in the Intensive Care Unit: We could Improve ICU Patients Safety

Hurtado¹,

Merchante²,

Ventura³

et al. 2018

Bedside Procedures

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Tracheal intubation is one of the most common and dangerous procedures in the intensive care units (ICU), and is usually done in more difficult conditions than in the operating room. Intubation failure can occur unexpectedly, and is the second most common event reflected in the ICU in the NAP4. Complications associated with airways were more likely to occur in ICU than in the operating room (severe hypoxemia, arrhythmia, hypotension, cardiovascular collapse, etc.), and generates more frequent damage to the patient. The theoretical benefits of videolaryngoscopes, as proper and correct use, offer the potential to reduce the difficulty of intubation in the ICU. In recent years, the role of videolaryngoscopes in ICU has been the subject of debate. Numerous studies have shown increased morbidity when performing multiple attempts at tracheal intubation. Videolaryngoscopes allow a view of the entrance of glottis independent of the line of sight, and have also been shown to improve glottis and intubation success rates in emergency and emergency services, in the prehospital setting, and specifically in patients with known predictors of difficult airway (DA).

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“…Mosier y cols 12 , han conceptualizado este fenóme-no bajo el término "vía aérea fisiológicamente difícil". Esto se refiere a que la presencia de estas alteraciones fisiológicas representadas por: hipoxemia, hipotensión, acidosis metabólica severa y falla ventricular derecha, pueden constituir un tipo de dificultad que también puede conducir a complicaciones y que es necesario pesquisar y compensar antes de manejar la vía aérea 13 .…”

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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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The Physiologically Difficult Airway

Cited by 178 publications

References 90 publications

Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

Predictors of arterial desaturation during intubation: a nested case-control study of airway management—part I

Videolaryngoscopy in the Intensive Care Unit: We could Improve ICU Patients Safety

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

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