A Technique of Awake Bronchoscopic Endotracheal Intubation for Respiratory Failure in Patients With Right Heart Failure and Pulmonary Hypertension

Abstract

Awake bronchoscopic intubation supported with a noninvasive positive pressure delivery systems may be feasible alternative to standard direct laryngoscopy approach. Further studies are needed to better assess its safety and applicability.

Advanced airway management and respiratory care in decompensated pulmonary hypertension

“…Induction with anesthetic agents lead to systemic vasodilation which can decrease coronary artery perfusion. The combination of increased myocardial oxygen demand and decreased coronary perfusion induce right ventricular ischemia, which can trigger hemodynamic collapse during intubation [7]. Consideration of conscious sedation as opposed to rapid sequence intubation (RSI) or not using any sedation should be considered prior to intubation.…”

“…1) [6]. PH patients with ARF commonly experience systemic hypotension and hypoxia due to a combination of their underlying acute and chronic pathophysiology often within 1 h of intubation [7]. These are often worsened during intubation, possibly from a combination of the following: (a) the effects of sedatives administered for intubation, (b) peri-intubation attempts at lung recruitment via noninvasive positive pressure ventilation (NIPPV), and (c) during the transition from spontaneous to positive pressure ventilation after intubation.…”

Management of Right Ventricular Failure in Pulmonary Embolism

“…In 1 small case series, patients with acute right heart failure intubated using this strategy had 88% survival in the 24 hours after intubation. 51 When performing fiberoptic intubation in this population, adequate topicalization with lidocaine should be emphasized to reduce abrupt shifts in sympathetic tone from the procedure. 52 Care should be taken to avoid lung overdistension both while bag masking the patient as well as after the patient is intubated.…”

Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department

“…Inexpensive disposable in‐line manometers are available for BVMs and their use is recommended to avoid excessive manual ventilation pressures, which can increase the risk of gastric insufflation and regurgitation . Alternatively, avoiding RSI altogether and performing an awake intubation is sometimes the most prudent course of action in the physiologically compromised patient . It is worth noting that a HNFC system can also be used during awake intubations to prevent desaturation …”

“…Alternatively, avoiding RSI altogether and performing an awake intubation is sometimes the most prudent course of action in the physiologically compromised patient . It is worth noting that a HNFC system can also be used during awake intubations to prevent desaturation …”