Use of the ProSeal Laryngeal Mask Airway to Initiate Ventilation During Intensive Care and Subsequent Percutaneous Tracheostomy

Abstract

The ProSeal Laryngeal Mask Airway is a supraglottic airway that aims to provide improved airway seal and separation of the gastrointestinal and respiratory tracts. We report two cases in which the ProSeal Laryngeal Mask Airway was used to initiate controlled ventilation in the intensive care unit and subsequently provide airway maintenance during percutaneous dilational tracheostomy. The first case involved a patient with a known difficult airway who had previously been impossible to intubate conventionally. In both cases, airway management and subsequent tracheostomy were performed without complication.

The proseal™laryngeal mask airway: a review of the literature

“…[86][87][88][89] On six occasions the PLMA secured airway rescue after failed intubation at rapid sequence induction (RSI). [90][91][92][93][94] Four were obstetric emergencies [91][92][93][94] and two non-obstetric.…”

“…96 THE ICU There are four reports of PLMA use in ICU. These include use in patients with intubation difficulty: for eight hours ventilation after failed intubation, 93 for securing the airway prior to immediate tracheostomy, 88 and for airway rescue after accidental extubation and failed reintubation. 89 The PLMA was used during bronchoscopic guided percutaneous tracheostomy in 25 patients.…”

Airway rescue in acute upper airway obstruction using a ProSeal™ Laryngeal mask airway and an Aintree Catheter™: a review of the ProSeal™ Laryngeal mask airway in the management of the difficult airway

“…There are a further 10 reports of airway rescue with the PLMA after failed intubation and/or failed ventilation (Table 2) [39–47]. In most cases these were extreme emergencies with progressive hypoxaemia.…”

“…In most cases these were extreme emergencies with progressive hypoxaemia. In all, there are four cases when the PLMA achieved airway rescue after ‘routine intubation’[38–41], and seven after rapid sequence induction (RSI) [42–47].…”

Airway control via the Cobrapla™ during percutaneous dilatational tracheotomy in five patients

“…[3][4][5][6] When using an ETT during PDT, the tube must be withdrawn partially in order to insert the cannula so that there is a risk of removing the ETT accidentally or rupturing the cuff. To our knowledge, there have been no reports discussing the use of any other supraglotic device other than LMAs for managing the airway during PDT.…”