Is it time for high flow nasal oxygen to be included in the difficult airway algorithm?

Shallik, Nabil A.; Karmakar, Anirban

doi:10.1016/j.bja.2018.05.052

Cited by 9 publications

(10 citation statements)

References 8 publications

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“…Moreover, recent guidelines published for the management of tracheal intubation in critically ill patients recommend using high-flow nasal oxygen therapy (HFNO) during and between tracheal intubation attempts [ 14 ]. On the other hand, the Difficult Airway Society (DAS) has suggested that high-flow nasal oxygen therapy (HFNO) may have a role in managing a difficult airway [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America

Granell

Sanchís

Delgado

et al. 2022

JCM

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Airway management during the COVID-19 pandemic has been one of the most challenging aspects of care that anesthesiologists and intensivists face. This study was conducted to evaluate the management of tracheal intubation in patients with suspected or confirmed COVID-19 infection. This is a cross-sectional and international multicenter study based on a 37-item questionnaire. The survey was available to physicians who had performed intubations and tracheostomies in patients with suspected or confirmed COVID-19 and had provided informed consent to participate. The primary outcome is the preference to use a specific device for tracheal intubation. Secondary outcomes are clinical practice variables, use of video laryngoscopes, difficult airway management, and safety features to prevent cross-infection. This study included 2411 physicians who performed an average of 11.90 and 20.67 tracheal intubations in patients diagnosed or suspected of having COVID-19 disease, respectively. Physicians were mainly from the specialties of Anesthesiology (61.2%) and Intensive Care (7.4%). COVID-19 infection diagnosed by positive PCR or serology in physicians participating in intubation in this study was 15.1%. Respondents considered preoxygenation for more than three minutes very useful (75.7%). The preferred device for tracheal intubation was the video laryngoscope (64.8%). However, the direct laryngoscope (57.9%) was the most commonly used, followed by the video laryngoscope (37.5%). The preferred device to facilitate intubation was the Eschmann guide (34.2%). Percutaneous tracheostomy was the preferred technique (39.5%) over the open tracheostomy (22%). The predicted or unpredicted difficult airway management in these patients was preferably performed with a video laryngoscope (61.7% or 63.7, respectively). Intubation was mostly performed by two or more expert airway physicians (61.6%). The use of personal protective equipment increased the practitioners’ discomfort during intubation maneuvers. The video laryngoscope is the preferred device for intubating patients with COVID-19, combined with the Eschmann guide, flexible stylet within the endotracheal tube, or Frova guide to facilitate intubation. The sub-analysis of the two groups of physicians by the level of intubation experience showed a higher use of the video laryngoscope (63.4%) in the experts group and no significant differences between the two groups in terms of cross-infection rates in physicians, in their preference for the use of the video laryngoscope or in the number of intubations performed in confirmed or suspected COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America

Granell

Sanchís

Delgado

et al. 2022

JCM

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“…11,12 According to the existing studies, apnea time can be extended up to 30 min; 13,14 therefore, starting high-flow nasal oxygenation immediately after the first failed intubation attempt in an unanticipated difficult intubation case may be beneficial for allowing sufficient time for clinicians to focus on performing intubation techniques. Interestingly, Shallik and Karmakar 9 suggested that high-flow nasal oxygenation might be included in the difficult airway algorithm. In our case, as high-flow nasal oxygenation was applied, the SpO 2 rate was maintained at 100%, and the delicate intubation process lasting 6 min could be safely performed without interference.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 In this situation, a high-flow nasal oxygenation method can aid in oxygen supply. 9 We report two cases that used high-flow nasal oxygenation in difficult airway conditions encountered after anesthesia induction.…”

Section: Introductionmentioning

confidence: 99%

Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

Lee

Kim

2021

SAGE Open Medical Case Reports

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In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

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“…It should be considered that the use of HFNO should be added to the difficult airway guidelines and that its areas of application should be expanded to special populations such as to those with reduced cardiopulmonary reserve, to children, and to obese and pregnant patients [88].…”

Section: Summary Of the Efficacy Of Hfnomentioning

confidence: 99%

High-flow nasal oxygenation for anesthetic management

Kim

2019

Korean J Anesthesiol

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High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.

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Is it time for high flow nasal oxygen to be included in the difficult airway algorithm?

Cited by 9 publications

References 8 publications

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America

Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

High-flow nasal oxygenation for anesthetic management

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