Survey of patients whose lungs could not be ventilated and whose trachea could not be intubated in university hospitals in Japan

Abstract

This survey demonstrates that CVCI can occur in any situation in which the airway is not established. Furthermore, effective treatments may be different depending on the situation, and delayed recognition of tracheal tube misplacement may lead to a serious outcome.

Strategies for the prevention of airway complications – a narrative review

“… full patient assessment and development of a patient‐specific airway strategy that is implementable by the present staff with the present equipment, communicated to all present and understood by all ; maintenance of oxygenation throughout airway management (pre‐ and per‐oxygenation via a patent airway); avoidance of trauma in all techniques used; optimal laryngoscopy, particularly emphasising early videolaryngoscopy and avoiding multiple attempts; airway rescue with a reliable (second generation) SAD inserted by a trained individual with good technique and avoiding multiple attempts; neuromuscular blockade when airway management becomes difficult, to facilitate mask ventilation and tracheal intubation ; good communication within the team to ensure transition to the next step of the strategy occurs in a timely fashion and is communicated to all present ; and an overarching understanding of how human factors impact on performance and outcome; cognitive aids and ‘action cards’ may have a role in avoiding task fixation. …”

“…Although most airway management undertaken by anaesthetists, intensivists and emergency physicians is routine, uneventful and uncomplicated, when complications do arise they can be catastrophic, with devastating outcomes for patients and clinicians alike . These events account for a significant proportion of fatalities and litigation related to anaesthesia .…”

Anaesthetic management of acute airway obstruction

“…It also avoids the risk of a post-induction 'cannot intubate, cannot ventilate' (CICV) scenario, which has an incidence of 0.01%-0.17%. (3,48) The two most common techniques are AFOI and awake tracheostomy, although they are not without risks. (3) Rarely are other techniques used in awake patients with AAO, such as direct or indirect laryngoscopy, (49,50) rigid bronchoscopy (51) and femoral vessel cannulation for cardiopulmonary bypass.…”

Anaesthesia for goitre surgery: A review

“…24 The reason for keeping the patient ‘awake’ and ‘spontaneously ventilating’ is to avoid the potentially catastrophic ‘cannot intubate, cannot ventilate’ (CICV) scenario (1 in 10,000 anaesthetic cases). 25 Therefore, predicting which patient will be difficult to ventilate and/or intubate (and therefore opting for the safer ‘awake’ options to secure the airway) is important.…”