Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults

Strametz, Reinhard; Bergold, Martin; Weberschock, Tobias

doi:10.1002/14651858.cd009901.pub3

Cited by 12 publications

(11 citation statements)

References 50 publications

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“…[1][2][3][4] An unsuitable LMA may lead to leaks, unsatisfactory ventilation, or injury. [1][2][3][4] The LMA size in adults is usually determined by weight, but this method could be inappropriate for Chinese men who weigh >70 kg. [1][2][3][4] In the present study, we used the Ambu AuraOnce laryngeal mask.…”

Section: Discussionmentioning

confidence: 99%

“…A laryngeal mask airway (LMA) is a supraglottic device (either single-use or reusable) that is used to temporarily maintain an open airway for the administration of anesthesia or during life-saving procedures. [1][2][3][4] An LMA is designed to be inserted blindly into the hypopharynx through the mouth (as the hypopharyngeal space where the device will be seated cannot be directly observed 5 ) and to create a seal immediately above the glottis opening. [1][2][3][4] Diverse methods of LMA size selection are available, including methods based on the patient's actual weight, standard weight, sex, height, distance between the nose and chin, tongue width, 6 distance between the mandibular second molars, 7 or distance between the cricoid cartilage and chin.…”

Section: Introductionmentioning

confidence: 99%

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Size selection of the Ambu AuraOnce laryngeal mask in Chinese men weighing >70 kg: a pilot study

Chen

et al. 2021

J Int Med Res

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Objective To collect computed tomography data of the laryngeal anatomy of Chinese men and to determine the feasibility of using the size 4 Ambu AuraOnce laryngeal mask (Ambu A/S, Copenhagen, Denmark) in Chinese men weighing >70 kg. Methods This prospective study involved men who underwent surgery from May 2018 to January 2019 at Jinshan Hospital. Pharyngeal and laryngeal parameters were measured by computed tomography. The laryngeal mask insertion success rate, requirement for tracheal tube insertion, laryngeal mask insertion time, fiberoptic bronchoscopy grading, air leakage pressure, and pharyngeal complications were analyzed. Results In a comparison of the size 4 and 5 Ambu AuraOnce devices, the first insertion success rate was 100% and 87% and the three-times insertion success rate was 100% and 93%, respectively, with no significant differences. However, the insertion time was significantly different at 19.6 ± 5.9 versus 31.1 ± 11.2 s, respectively, and the proportions of fiberoptic grading levels were also significantly different. There were no significant differences in the air leakage pressure or pharyngeal complications. Conclusion The size 4 Ambu AuraOnce is more adequate than the size 5 for Chinese men weighing >70 kg, with a shorter insertion time and higher fiberoptic bronchoscopic grading.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Size selection of the Ambu AuraOnce laryngeal mask in Chinese men weighing >70 kg: a pilot study

Chen

et al. 2021

J Int Med Res

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“…However, there is an ongoing debate on whether laryngeal masks should be used for PDT. In this regard, a recent Cochrane analysis [27] revealed a higher probability of a failing procedure and an uncertainty of serious adverse events when using laryngeal masks. Furthermore, at least in the ICU setting used for the current study changing the airway access is at risk for even severe complications, and this should be weighted against the benefit of a less severe increase in PCO 2 .…”

Section: Discussionmentioning

confidence: 99%

Respiratory acidosis during bronchoscopy-guided percutaneous dilatational tracheostomy: impact of ventilator settings and endotracheal tube size

et al. 2019

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Background: The current study investigates the effect of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) on the evolution of respiratory acidosis depending on endotracheal tube (ET) sizes. In addition, the impact of increasing tidal volumes during the intervention was investigated. Methods: Two groups of ICU-patients undergoing bronchoscopy-guided PDT with varying tidal volumes and tube sizes were consecutively investigated: 6 ml/kg (N = 29, mean age 57.4 ± 14.5 years) and 12 ml/kg predicted body weight (N = 34, mean age 59.5 ± 12.8 years). Results: The mean intervention time during all procedures was 10 ± 3 min. The combination of low tidal volumes and ETs of 7.5 mm internal diameter resulted in the most profound increase in PaCO 2 (32.2 ± 11.6 mmHg) and decrease in pH-value (− 0.18 ± 0.05). In contrast, the combination of high tidal volumes and ETs of 8.5 mm internal diameter resulted in the least profound increase in PaCO 2 (8.8 ± 9.0 mmHg) and decrease of pH (− 0.05 ± 0.04). The intervention-related increase in PaCO 2 was significantly lower when using higher tidal volumes for larger ET: internal diameter 7.5, 8.0 and 8.5: P > 0.05, =0.006 and = 0.002, respectively. Transcutaneous PCO 2 monitoring revealed steadily worsening hypercapnia during the intervention with a high correlation of 0.87 and a low bias of 0.7 ± 9.4 mmHg according to the Bland-Altman analysis when compared to PaCO 2 measurements. Conclusions: Profound respiratory acidosis following bronchoscopy-guided PDT evolves in a rapid and dynamic process. Increasing the tidal volume from 6 to 12 ml/kg PBW was capable of attenuating the evolution of respiratory acidosis, but this effect was only evident when using larger ETs.

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“…Withdrawal of the ETT to the level of the vocal cords, as described by Ciaglia et al (2), carries multiple potential risks, including accidental extubation, continued leak even with the cuff inflated, and inability to visualize the tracheal anatomy through the bronchoscope due to ETT position; thus, conversion of the airway to a LMA has been suggested as a way of avoiding these complications (28). In a 2018 Cochrane review, reviewers were able to find nine studies evaluating whether an LMA carries any advantage over an ETT for PDT (29). The median procedure time was shorter by about 1.5 min in the LMA group, while the risk of procedure failure, defined as conversion to an alternate procedure or abandonment of PDT, was about 3 times greater in the LMA group, with most failures resulted in completing the PDT procedure with an ETT.…”

Section: Lmamentioning

confidence: 99%

Percutaneous dilational tracheostomy: current techniques and evidence of safety

Ghori¹,

Chambers²

2020

Shanghai Chest

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Tracheostomy has transitioned from being the complete domain of surgeons, as described by Chevalier Jackson in early 20th century, to a procedure shared by intensivists and interventional pulmonologists in form of percutaneous dilatational tracheostomy. This procedure is commonly performed in intensive care units to facilitate long-term mechanical ventilation for chronic respiratory failure, but other less frequent indications also exist. The commonly practiced techniques for percutaneous dilational tracheostomy rely on passage of tools over a guidewire, with the Ciaglia technique being the most popular and having the best safety profile. Adjunctive techniques include use of bronchoscopy, bedside ultrasonography, and laryngeal mask airway (LMA). In properly selected patients, percutaneous dilational tracheostomy carries a good safety profile, but some patient characteristics may increase the risk of complications; thus, the procedure is complimentary to surgical tracheostomy (ST) and not a complete replacement. Bedside ultrasound and bronchoscopy are routinely available instruments in most intensive care units, although there is limited evidence of improved safety with these adjuncts. In properly selected patients, percutaneous dilational tracheostomy can be a safe and cost-effective alternative to ST.

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Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults

Cited by 12 publications

References 50 publications

Size selection of the Ambu AuraOnce laryngeal mask in Chinese men weighing >70 kg: a pilot study

Size selection of the Ambu AuraOnce laryngeal mask in Chinese men weighing >70 kg: a pilot study

Respiratory acidosis during bronchoscopy-guided percutaneous dilatational tracheostomy: impact of ventilator settings and endotracheal tube size

Percutaneous dilational tracheostomy: current techniques and evidence of safety

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