What’s new in airway management of the critically ill

Russotto, Vincenzo; Myatra, Sheila Nainan; Laffey, John G.

doi:10.1007/s00134-019-05757-0

Cited by 36 publications

(29 citation statements)

References 17 publications

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“…For the VSC, time to successful intubation was far longer. Although this did not have a relevant influence on oxygen saturation or carbon dioxide accumulation it may be of importance in pre-hospital or critically ill patients with acute respiratory dysfunction and impaired oxygenation ( 29 ). Interestingly, an improved visualization of the laryngeal inlet with an increased time to intubation has been shown recently for a different device for intubation, as well ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Elective Tracheal Intubation With the VieScope—A Prospective Randomized Non-inferiority Pilot Study (VieScOP-Trial)

et al. 2022

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BackgroundTracheal intubation is commonly performed after direct laryngoscopy using Macintosh laryngoscopes (MacL), but visualization of the larynx may be inadequate. The VieScope (VSC) as a new type of laryngoscope consisting of a straight, shielded, illuminated tube used to perform intubation via a bougie was investigated in this prospective randomized trial in patients without expected difficult airways.MethodsWith ethics approval, 2 × 29 patients for elective surgery were randomized 1:1 to intubation with VSC or MacL. Endpoints were first attempt success rates (FAS), Percentage of Glottis Opening Scale (POGO), time to intubation (TTI), and difficulty ratings on visual analog scales (0–100, lower values better). Data are given as mean ± standard deviation.ResultsThe FAS was 83 ± 38% for VSC and 86 ± 34% for MacL (P = 0.723). For VSC, POGO was 86 ± 17% and for MacL 68 ± 30% (P = 0.007). TTI for VSC was 93 ± 67s vs. 38 ± 17 for MacL (P < 0.001). Difficulty of intubation was rated 23 ± 22 for VSC vs. 18 ± 22 for MacL (P = 0.422), viewing conditions 12 ± 15 vs. 24 ± 25 (P = 0.031), and difficulty of tube placement was rated 27 ± 30 vs. 7 ± 8 (P = 0.001).ConclusionNo difference in FAS was detected between VSC and MacL. Visualization of the larynx was superior using the VSC, while TTI was prolonged and tube placement via bougie was more challenging. The VSC could be an alternative to MacL in patients with difficult laryngoscopy, but this should be investigated further in patients with expected difficult airways.

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Section: Discussionmentioning

confidence: 99%

Elective Tracheal Intubation With the VieScope—A Prospective Randomized Non-inferiority Pilot Study (VieScOP-Trial)

et al. 2022

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“…Given the importance in achieving first pass success in order to reduce adverse events, different adjuncts to facilitate tracheal intubation have been investigated to overcome anatomical difficulties. 1,47,48 In a randomised study performed in a single US Emergency Department, critically ill patients undergoing tracheal intubation with a Macintosh blade (direct laryngoscopy or videolaryngoscopy) were randomised to the use of either bougie or stylet. All the patients included had at least one anatomical predictor of difficult airway management.…”

Section: Adjuncts To Facilitate Tracheal Intubationmentioning

confidence: 99%

“…1 The term 'physiologically difficult airway' has been introduced to describe the features of airway management in critically ill patients, whose disordered physiology poses specific challenges in addition to the anatomical difficulty, which may be encountered in the anaesthesia setting. 1 Additional considerations are operator variables with differing levels of expertise and training. Finally, even the location of the procedure, with varying levels of human and equipment resources available, may also play a role.…”

Section: Introductionmentioning

confidence: 99%

Tracheal intubation in the critically ill patient

Russotto

Rahmani

Parotto

et al. 2021

European Journal of Anaesthesiology

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Tracheal intubation is among the most commonly performed and high-risk procedures in critical care. Indeed, 45% of patients undergoing intubation experience at least one major peri-intubation adverse event, with cardiovascular instability being the most common event reported in 43%, followed by severe hypoxemia in 9% and cardiac arrest in 3% of cases. These peri-intubation adverse events may expose patients to a higher risk of 28-day mortality, and they are more frequently observed with an increasing number of attempts to secure the airway. The higher risk of peri-intubation complications in critically ill patients, compared with the anaesthesia setting, is the consequence of their deranged physiology (e.g. underlying respiratory failure, shock and/or acidosis) and, in this regard, airway management in critical care has been defined as ''physiologically difficult''. In recent years, several randomised studies have investigated the most effective preoxy-genation strategies, and evidence for the use of positive pressure ventilation in moderate-to-severe hypoxemic patients is established. On the other hand, evidence on interventions to mitigate haemodynamic collapse after intubation has been elusive. Airway management in COVID-19 patients is even more challenging because of the additional risk of infection for healthcare workers, which has influenced clinical choices in this patient group. The aim of this review is to provide an update of the evidence for intubation in critically ill patients with a focus on understanding peri-intubation risks and evaluating interventions to prevent or mitigate adverse events.

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“…Tracheal intubation is one of the most commonly performed procedures in the intensive care unit (ICU) [1]. In a recent prospective observational study (INTUBE study) including 2964 patients across 29 countries, adverse event occurred after intubation in 45.2% of patients, including cardiovascular instability in 42.6%, severe hypoxemia in 9.3%, and cardiac arrest in 3.1% [2].…”

mentioning

confidence: 99%

“…However, since this study was performed using direct laryngoscopes, these results should be cautiously extrapolated to Macintosh videolaryngoscopes. Another potential limitation is that the authors used first pass success as their primary outcome, considering the high incidence of complications during tracheal intubation in the critically ill, first pass success without adverse events may be a better endpoint [1,9].…”

mentioning

confidence: 99%