Extubation and Changing Endotracheal Tubes

Cooper, Richard M.

doi:10.1016/b978-032302233-0.50056-1

Cited by 19 publications

(18 citation statements)

References 259 publications

(284 reference statements)

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“…1 The potential for airway misadventure may be compounded by epistaxis that interferes with visualization and securing the airway with conventional (non-surgical) techniques. 2 Piepho et al 2 advocate to "look before you leap" prior to nasotracheal intubation: that is, to determine by direct laryngoscopy the potential for a difficult intubation (Cormack-Lehane classification), and to refrain from passing the endotracheal tube through the nose unless confronted by a class 1 or 2 view (see Figure).…”

mentioning

confidence: 99%

Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view

Uria

Kost

Schricker

et al. 2008

Can J Anesth/J Can Anesth

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mentioning

confidence: 99%

Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view

Uria

Kost

Schricker

et al. 2008

Can J Anesth/J Can Anesth

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“…The airway exchange catheter (AEC) has been a suggested as part of an extubation strategy when managing difficult airways that may require re‐intubation . The AEC is a long hollow tube inserted through a tracheal tube before extubation.…”

Section: Resultsmentioning

confidence: 99%

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

et al. 2016

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Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment. The findings in the section on Intensive Care and Emergency Medicine reinforce the importance of good airway management in the critical care environment and, in particular, the need for appropriate guidelines to improve patient safety. This narrative review focuses on strategies for safe extubation of the trachea for patients with potentially difficult upper airway problems in the intensive care unit.

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“…When the existing ETT is blocked by foreign body such as mucus plug in children with difficult airways, this sheath should not be used for the ETT exchange because of a risk of dislodging the obstructed matter in a caudal direction to become foreign body in the trachea. Under this circumstance, the ETT exchange using a FOB should be used as first option (5). After a thin FOB is inserted into the trachea along the obstructed ETT, the obstructed ETT is carefully withdrawn and the replacement ETT is then inserted into the trachea over the FOB.…”

mentioning

confidence: 99%

Extubation and endotracheal tube exchange using a guidewire sheath in management of difficult pediatric airways

Xue

Zhang

Liao

et al. 2009

Pediatric Anesthesia

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occur and create a cannot ventilate, cannot intubate scenario (5). When a tube with an intubating stylet can not inserted into the glottis by two to three attempts under the left paraglossal laryngoscopy in the CL ⁄ P children, therefore, we often combine some other measures to achieve successful intubation and safe airway management: (i) Combined use of the left paraglossal laryngoscopy and lightwand technique is often our first line option. Under the guide of laryngoscopy, the lightwand may easily be positioned at the laryngeal aperture according to transillumination of soft tissues of the anterior neck. When the cricothyroid membrane is transilluminated, the ETT is inserted into the trachea along the lightwand; (ii) The gum elastic bougie guided intubation described by Semjen et al. (6) is another useful alternative. Before insertion of the gum elastic bougie, the child's head is rotated to the right to improve visualization while applying external laryngeal pressure displacing the larynx to the left. Because a gum elastic bougie is longer than a styletted ETT, it can be manipulated without occluding the laryngeal view by the anesthetist right hand. Also the smaller diameter of a gum elastic bougie compared to the styletted ETT may decrease the interference to the restricted laryngeal view under the left paraglossal laryngoscopy. Additionally, our experience suggests that compared with the left paraglossal laryngoscopy using a Miller blade, the left paraglossal laryngoscopy using a same size Macintosh blade can make insertion of the lightwand or gum elastic bougie easier because the Macintosh blade with a curved tongue spatula and a winder flange can make a larger room for device manipulation, and (iii) If the above measures fail, the fiberoptic intubation under the left paraglossal laryngoscopy is a favorable selection of airway rescue, especially for when the laryngeal view is C&L class 4. We find that use of the left paraglossal laryngoscopy can provide a clear airway for the fiberscopy and allow identification of laryngeal structures using the fiberoptic bronchoscope.It must be emphasized that when intubation with the left paraglossal laryngoscopy fails and subsequently facemask ventilation is difficult, a laryngeal mask airway should be immediately inserted. Then the fiberoptic intubation is performed through it (7).Finally, we agree the authors' view that the left paraglossal laryngoscopy technique needs to be practiced in children with a normal upper airway before using it for airway management of the bilateral CL ⁄ P children.

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Extubation and Changing Endotracheal Tubes

Cited by 19 publications

References 259 publications

Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view

Case report: Nasotracheal intubation — look before leaping to assess the laryngeal view

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

Extubation and endotracheal tube exchange using a guidewire sheath in management of difficult pediatric airways

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