Supraglottic devices — future or everyday life?

Abstract

The most common cause of upper respiratory tract obstruction in an unconscious or unresponsive patient is the loss of muscle tone in the upper airway. Consequently, this leads to a reduction in the tone of the epiglottis, collapse of the tongue and closure of the airway at the level of the pharynx, preventing respiration. Diagnosing airway obstruction is associated with the implementation of urgent procedures aimed at restoring and maintaining patency. Among the techniques of restoring airway patency anatomically, we prefer extending the head and pushing the posterior mandible forward. Airway ventilation is not always possible through the use of non-surgical methods. Ventilating patients with obstructed airways using a self-inflating bag can prove to be very difficult. In such situations, it is necessary to use airway adjuncts. The purpose, regardless of the circumstances, is to remove anatomical barriers, prevent gastric aspiration and to facilitate proper lung ventilation. Endotracheal intubation is the gold standard for instrumentally maintaining a secure airway. The procedure, however, is reserved for experienced personnel because of how difficult it is to perform and the many complications that arise with it. In situations where difficulty is encountered, an alternative device to secure airway patency is needed.

Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand

“…[ 12 – 14 ] Supraglottic airway devices do not prevent pulmonary aspiration of gastric content, a common and serious clinical concern. [ 15 ] However, once the airway is secured by a supraglottic airway and ventilation is restored, the trachea can be intubated through some types of supraglottic airway devices. Intubation through these devices can be performed using a fiberoptic bronchoscope or blindly, meaning that the tube is inserted through the supraglottic airway device without direct visualization of the airway.…”

Use of video laryngoscopes by inexperienced personnel in difficult intubations

“…Endotracheal intubation is regarded as the best method of securing an airway in both the hospital and prehospital setting [1,2]. According to the recommendations of the European Resuscitation Coun-cil (ERC), endotracheal intubation is the best method to maintain an airway during sudden cardiac arrest, where a patient's oxygen reserves can be as short as 3-5 minutes [3].…”

Supraglottic airway devices – a conceit or the future of airway management?

“…In this study, the authors present the effectiveness of airway management with the use of CombiTube by firefight ers. According to numerous studies, the learning curve of supraglottic ventilation devices is signifi cantly shorter than that of direct laryngoscopy [2,3]. The history of supraglottic airway devices (SADs) dates back to the early 1980s.…”

“…This procedure is designed to prevent air leaks in the event of increased chest pressure -as is the case with chest compressions. If the person auscultating the upper abdomen does not hear murmurs sug gesting air leaks, asynchronous cardiopulmonary re suscitation is permitted [3]. As indicated by numer ous studies supraglottic airway devices can be used with high efficiency after a short training, so that they can be used, among others, by the firefighters mentioned by Frass et al or nurses [1].…”