Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

Abstract

ObjectivesTo create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians.MethodsThis is a narrative review combined with a structured Medline literature search.ResultsUltrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size.ConclusionsUltrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits.Teaching Points• Ultrasonography is becoming essential in management of the upper and lower airways.• The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation.• Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax.• Point-of-care ultrasonography of the airways has a steep learning curve.• Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.

Ultrasound Guidance in Detection of Pneumothorax and Thoracentesis Performance:a Review

“…Moreover emergency departments, Meta-analysis Reports also revealed the sensitivity of 78.6-90.9 % and specif icity of 98.2-98.4 % for US which chests radiographs had showed sensitivity of 39.8-50.2 % and specif icity of 99.3-99.4 % (Alrajhi 2012; Alrajab ., 2013). Lung sliding, B-lines, lung pulse, and lung point are some features which can help pneumothorax to be detected or omitted by the US (Volpicelli , 2012).Lung sliding or B-lines can exclude pneumothorax when we report them on the anterior surface of a supine patient's chest (Lichtenstein 2005;Soldati , 2008;Ebrahimi , 2014;Kristensen , 2014;Obrador 2014). A meta-analysis by Ebrahimi (2014) indicated that the diagnostic accuracy of US was higher than supine CXR for diagnosis of pneumothorax.…”

“…The pooled sensitivity and specif icity of CXR were 0.46 and 1.0, respectively. A study by Kristensen (2014) showed that Ultrasonography is a reliable device for intraoperative and emergency diagnosis of pneumothorax. The US provide us diagnosis and management of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiate etiologies of acute breathlessness during pregnancy.…”

Comparison of the C-Mac video laryngoscope with the McGrath Series 5 video laryngoscope concerning an extremely difficult airway

“…The literature has reported numerous cases (concerning as much as 27% of study participants) in which SpO 2 in mothers dropped to 91−92% and the use of oxygen was necessary [4]. In recent years even more alarming reports have been published.…”

“…Airway ultrasound, which is a simple and noninvasive procedure, enables visualisation of the larynx and trachea and can help perform tracheotomy in very "difficult" patients. Ultrasound of the larynx and trachea is recommendable in all patients with potential difficult airway [4].…”

“…However, it should also be pointed out that during the second decade of the 21st century, opinions as to the administration of this drug are no longer so clear [4,9,10].…”