Management of the Traumatized Airway

Abstract

Previous reviews have addressed airway management of trauma patients without a detailed description of management of the traumatized airway. This clinical commentary focuses on the approach to patients with upper airway trauma.

Awake tracheal intubation for blunt airway trauma

“…Furthermore, there was a desire to avoid a strategy which may further displace the damaged structures or cause further trauma to the airway. The decision to monitor these patients should be done so in the knowledge that oedema and haemorrhage can continue to develop over a matter of days, therefore, observation in critical care is an appropriate strategy . The largest observational dataset on laryngeal fractures, taken from emergency department attendances in the USA, suggests the percentage of patients requiring urgent tracheal intubation or tracheostomy is lower than has previously been reported (2.6% and 0.1%, respectively), whereas unselected data on blunt airway trauma suggest many more require some form of airway management and 50% require a tracheostomy .…”

“…Due to the relative rarity and complexity of airway trauma, there is a lack of evidence regarding its acute management, which is reflected in the absence of published consensus or guidelines . Description of rates of emergent tracheal intubation in these cases are highly variable, ranging from 2.6% to 80%, although variability in individual study populations and definitions are likely to play a role in this finding .…”

“…Due to the relative rarity and complexity of airway trauma, there is a lack of evidence regarding its acute management, which is reflected in the absence of published consensus or guidelines . Description of rates of emergent tracheal intubation in these cases are highly variable, ranging from 2.6% to 80%, although variability in individual study populations and definitions are likely to play a role in this finding . The literature appears to advocate for a multidisciplinary approach with an emphasis on prompt diagnosis and management; however, the uncertainty with regard to the need for definitive surgical management perhaps underlies the lack of agreed, published guidance .…”

Neck Trauma and Extra-tracheal Intubation

“…Although direct neck injury is uncommon and only accounts for 1:30,000 emergency room visits, 1 airway trauma remains a major cause of early death in trauma. 2 , 3 Airway obstruction or associated injury (i.e., retropharyngeal hematoma) is estimated to account for a 30% early mortality rate. 2 , 4 Early recognition and security of the airway remains a priority in resuscitating patients with airway compromise.…”

“… 2 , 3 Airway obstruction or associated injury (i.e., retropharyngeal hematoma) is estimated to account for a 30% early mortality rate. 2 , 4 Early recognition and security of the airway remains a priority in resuscitating patients with airway compromise. However, there is limited evidence on how to manage traumatic airways.…”