The difficult airway in the emergency department
Identifieur interne : 005E67 ( Main/Exploration ); précédent : 005E66; suivant : 005E68The difficult airway in the emergency department
Auteurs : Evelyn Wong [Singapour] ; Yih-Yng Ng [Singapour]Source :
- International Journal of Emergency Medicine [ 1865-1372 ] ; 2008.
Abstract
The patient with difficult airways is a common challenge for emergency physicians.
Our goal was to study the reasons for difficult airways in the emergency department.
We performed a prospective observational study of patients requiring advanced airway management from 1 January 2000 to 31 December 2006.
There were 2,343 patients who received advanced airway management of which 93 (4.0%) were deemed difficult. The main diagnoses were cardiac arrest (28), trauma (27) and congestive heart failure (10). The main reasons for the difficult airways were attributed to an anterior larynx (38, 40.9%), neck immobility (22, 23.7%) as well as the presence of secretions and blood (14, 15.1%). The mean number of attempts at intubation was 3.6 versus 1.2 for all cases. The mortality rate of 40.5% among patients with difficult airways was not different from that of all patients who had airway management (41%). There were seven (0.3%) failed airways. Anaesthetists performed 21 (22.6%) of the rescue airways while surgeons performed 5 (5.4%). Of the rescue strategies performed, 24 were through the use of the bougie, 3 by cricothyroidotomy, 4 by tracheostomy, 6 with the GlideScope and 3 with the laryngeal mask airway. The rest the airways were secured by tracheal intubation using the laryngoscope.
Emergency physicians manage most of the difficult airways successfully (68.8%). However, the success rate can be further improved through the more frequent use of the bougie or other rescue device. A possible suggestion would be for the emergency physician to use the bougie after the second or third attempt at direct orotracheal intubation.
Url:
DOI: 10.1007/s12245-008-0030-6
PubMed: 19384660
PubMed Central: 2657243
Affiliations:
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The main diagnoses were cardiac arrest (28), trauma (27) and congestive heart failure (10). The main reasons for the difficult airways were attributed to an anterior larynx (38, 40.9%), neck immobility (22, 23.7%) as well as the presence of secretions and blood (14, 15.1%). The mean number of attempts at intubation was 3.6 versus 1.2 for all cases. The mortality rate of 40.5% among patients with difficult airways was not different from that of all patients who had airway management (41%). There were seven (0.3%) failed airways. Anaesthetists performed 21 (22.6%) of the rescue airways while surgeons performed 5 (5.4%). Of the rescue strategies performed, 24 were through the use of the bougie, 3 by cricothyroidotomy, 4 by tracheostomy, 6 with the GlideScope and 3 with the laryngeal mask airway. The rest the airways were secured by tracheal intubation using the laryngoscope.</p></sec><sec><title>Conclusions</title><p>Emergency physicians manage most of the difficult airways successfully (68.8%). However, the success rate can be further improved through the more frequent use of the bougie or other rescue device. A possible suggestion would be for the emergency physician to use the bougie after the second or third attempt at direct orotracheal intubation.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Burkle, Cm" uniqKey="Burkle C">CM Burkle</name></author><author><name sortKey="Walsh, Mt" uniqKey="Walsh M">MT Walsh</name></author><author><name sortKey="Harrison, Ba" uniqKey="Harrison B">BA Harrison</name></author><author><name sortKey="Curry, Tb" uniqKey="Curry T">TB Curry</name></author><author><name sortKey="Rose, Sh" uniqKey="Rose S">SH Rose</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Samsoon, Glt" uniqKey="Samsoon G">GLT Samsoon</name></author><author><name sortKey="Young, Jrb" uniqKey="Young J">JRB Young</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Crosby, Et" uniqKey="Crosby E">ET Crosby</name></author><author><name sortKey="Cooper, Rm" 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uniqKey="Ng Y" first="Yih-Yng" last="Ng">Yih-Yng Ng</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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