The Importance of Transtracheal Jet Ventilation in the Management of the Difficult Airway

Benumof, Jonathan L.; Scheller, Mark S.

doi:10.1097/00000542-198911000-00023

Cited by 261 publications

(95 citation statements)

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“…Difficult tracheal intubation remains a major source of morbidity and mortality, in the operating theatre [1][2][3] and in the emergency setting [4,5]. Difficult or failed tracheal intubation is an important cause of anaesthetic death and brain damage [6][7][8][9][10][11]. These issues have stimulated the development of 'indirect' laryngoscopes, with the aim of reducing the difficulty obtaining a laryngeal view.…”

mentioning

confidence: 99%

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

McElwain¹,

Simpkin

Laffey³

2011

Anaesthesia

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SummaryThe purpose of this study was to determine whether the Intubation Difficulty Scale is meaningful when used with indirect laryngoscopes. Data were analysed from previously published clinical trials from our group that compared the indirect laryngoscopes with the Macintosh laryngoscope. For each laryngoscope type, the Intubation Difficulty Scale score obtained for each tracheal intubation was correlated with data for duration of the intubation attempt and with the user rated difficulty of the intubation attempt. The strengths of the correlations between these indices were then compared for tracheas intubated with the Macintosh vs the indirect laryngoscopes. The Intubation Difficulty Scale performed well when compared with data for duration and user rated difficulty of the intubation attempts for the both direct and indirect laryngoscopy. However, the correlation between the Intubation Difficulty Scale score and both user rated difficulty (p = 0.001) and the duration of tracheal intubation (p = 0.003) were significantly stronger for the Macintosh laryngoscope compared with the indirect laryngoscopes. In contrast, the correlation between user rated difficulty scores and the data for duration of tracheal intubation was not different between the device types. The Intubation Difficulty Scale performs less well with indirect laryngoscopes than with the Macintosh laryngoscope. These findings suggest the need for caution with the use of this score with indirect laryngoscopes. Difficult tracheal intubation remains a major source of morbidity and mortality, in the operating theatre [1][2][3] and in the emergency setting [4,5]. Difficult or failed tracheal intubation is an important cause of anaesthetic death and brain damage [6][7][8][9][10][11]. These issues have stimulated the development of 'indirect' laryngoscopes, with the aim of reducing the difficulty obtaining a laryngeal view. Many such devices now exist on the market, including the Glidescope [12, 13], Airtraq [14], Pentax Airway Scope (AWS) [12,15,16], TruView [12,16], and LMA C-Trach [17]. One difficulty encountered investigating the utility of these devices is the lack of a gold standard descriptor for intubation difficulty. While indices such as the duration of tracheal intubation attempts and user rated scores of the difficulty of laryngoscopy and intubation are useful, they do not provide a complete picture. A more objective scoring system might serve as a reproducible quantitative means of overcoming some of these limitations.Adnet et al. proposed the Intubation Difficulty Scale (IDS), which incorporates seven parameters (see Appendix 1) [18], for use when describing direct laryngoscopy and intubation. More recently, the IDS has been used to describe difficulty of laryngoscopy and tracheal intubation with indirect laryngoscopes in multiple studies by our group [13,16,17] and others [15,19]. However, the validity of the IDS when used with indirect laryngoscopes has not been evaluated.

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confidence: 99%

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

McElwain¹,

Simpkin

Laffey³

2011

Anaesthesia

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“…AFOI under conscious sedation was considered to be safe and the only option to avoid complications. According to Benumof et al [8], AOFI is also the safest approach of the airway management in the patients with predicted DMV. Inadequateventilation occurs in up to 38% of patients with facial injuries reported by Caplan et al [9].…”

Section: Discussionmentioning

confidence: 99%

“…Inadequateventilation occurs in up to 38% of patients with facial injuries reported by Caplan et al [9]. Benumof et al [8] estimated that up to 30% of deathsare due to inability of successful airway management.…”

Section: Discussionmentioning

confidence: 99%

Conscious Sedation and Awake Fiberoptic Intubation in a Patient with Difficult Mask Ventilation—A Case Report

Baral¹,

Ide²,

Uzawa³

et al. 2015

OJAnes

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Since maxillofacial malignancy is a common cause of facial defects and disfigurement of the face that may make fitting of a mask difficult and cause air leakage from the side, thus making mask ventilation difficult. In addition, distorted anatomy of the airway and base of the skull in such patients may cause difficult intubation (DI). We experienced a case with a huge facial defect due to maxillary carcinoma, in which difficult mask ventilation (DMV) and DI were predicted. After evaluation by three-dimensional airway computed tomography, the airway was secured with conscious sedation using dexmedetomidine, and awake fiberoptic intubation was safely performed. Three-dimensional airway computed tomography seems to be a good tool for successful intubation when DMV and DI are predicted.

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“…With this catheter in place, jet ventilation with oxygen can protect the patient from lethal hypoxemia should total airway obstruction occur during attempts to secure the airway with other airway management techniques. Rather than employing transtracheal jet ventilation as a rescue technique during a "cannot intubate, cannot ventilate" crisis, 15 VDCT, as described in this paper, can contribute to the successful management of the difficult airway scenario where supraglottic obstruction is a feature.…”

Section: Complicationsmentioning

confidence: 99%

Preemptive vessel dilator cricothyrotomy aids in the management of upper airway obstruction

Boyce

Peters

Carroll

et al. 2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Our objective was to demonstrate that preemptive vessel dilator cricothyrotomy may be useful when managing the patient with airway obstruction.M Me et th ho od ds s: : An Institutional Review Board approved retrospective study was undertaken in 88 patients for whom this technique was selected. The anesthesiologists and surgeons identified as authors were directly involved in the care of these patients. All vessel dilator cricothyrotomies were performed in the operating rooms of University Hospital, UAB, Medical Center. The patients selected for this airway management technique were afflicted with some type of supraglottic lesion, usually squamous cell carcinoma, which was obstructing their airways to an extent that complete airway obstruction during induction of anesthesia was a significant possibility.Prior to induction of anesthesia, the vessel dilator was inserted into the tracheal lumen through the cricothyroid membrane as described. Oxygenation was maintained with jet ventilation from a Sanders jetting device. Age, sex, weight, initial and lowest O 2 saturation, first recorded ETCO 2 , blood pressure and duration of jet ventilation were recorded. R Re es su ul lt ts s: : The airways were successfully managed in all 88 patients with this technique. There were no deaths, and no postoperative hypoxic sequelae; also complications were minor.

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The Importance of Transtracheal Jet Ventilation in the Management of the Difficult Airway

Cited by 261 publications

References 0 publications

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

Determination of the utility of the Intubation Difficulty Scale for use with indirect laryngoscopes

Conscious Sedation and Awake Fiberoptic Intubation in a Patient with Difficult Mask Ventilation—A Case Report

Preemptive vessel dilator cricothyrotomy aids in the management of upper airway obstruction

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