Abstract
An understanding of airway management skills and concepts is essential for any clinician. Maintaining a patent airway is a prerequisite for successful ventilation and oxygenation, and even a temporary lapse in airway patency can lead to permanent, potentially fatal consequences. The first successful attempt at creating an artificial airway dates to 1667, when Robert Hooke inserted a narrow-lumen tube into a dog’s trachea and then manually insufflated the dog’s lungs using a bellows. The need for airway proficiency combined with technological advancement in fields such as laryngoscopy allowed physicians to improve the standard of care in airway management after World War I, and by the mid-1920s, most patients were intubated under direct laryngoscopic vision. The basic fundamentals of airway management have remained largely unchanged since that time. This chapter discusses basic airway skills such as proper patient positioning and mask ventilation. It will also describe how to conduct a focused airway examination and give a short overview of how to proceed if a difficult airway is encountered. Surgical airway techniques and their complications will also be covered in detail.
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References
McNicol L, Mackay P. Anaesthesia-related morbidity in Victoria: a report from 1990 to 2005. Anaesth Intensive Care. 2010;38(5):837–48.
McWhorter AJ. Tracheotomy: timing and techniques. Curr Opin Otolaryngol Head Neck Surg. 2003;11(6):473–9.
Nathens AB, Rivara FP, Mack CD, Rubenfeld GD, Wang J, Jurkovich GJ, et al. Variations in rates of tracheostomy in the critically ill trauma patient. Crit Care Med. 2006;34(12):2919–24.
Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689–94.
Mallick A, Bodenham AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol. 2010;27(8):676–82.
Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000;118(5):1412–8.
Melloni G, Muttini S, Gallioli G, Carretta A, Cozzi S, Gemma M, et al. Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up. J Cardiovasc Surg (Torino). 2002;43(1):113–21.
Clec’h C, Alberti C, Vincent F, Garrouste-Orgeas M, de Lassence A, Toledano D, et al. Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis. Crit Care Med. 2007;35(1):132–8.
Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989;96(1):178–80.
Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008;36(9):2547–57.
Blot S, Rello J, Vogelaers D. What is new in the prevention of ventilator-associated pneumonia? Curr Opin Pulm Med. 2011;17(3):155–9.
MacIntyre NR, Cook DJ, Ely Jr EW, Epstein SK, Fink JB, Heffner JE, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S–95S.
Higgins KM, Punthakee X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope. 2007;117(3):447–54.
Dulguerov P, Gysin C, Perneger TV, Chevrolet JC. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med. 1999;27(8):1617–25.
Erlandson MJ, Clinton JE, Ruiz E, Cohen J. Cricothyrotomy in the emergency department revisited. J Emerg Med. 1989;7(2):115–8.
Wright MJ, Greenberg DE, Hunt JP, Madan AK, McSwain Jr NE. Surgical cricothyroidotomy in trauma patients. South Med J. 2003;96(5):465–7.
Wood DE, Mathisen DJ. Late complications of tracheotomy. Clin Chest Med. 1991;12(3):597–609.
Heffner JE, Miller KS, Sahn SA. Tracheostomy in the intensive care unit. Part 2: complications. Chest. 1986;90(3):430–6.
Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med. 2003;24(3):457–71.
Leonard RC, Lewis RH, Singh B, van Heerden PV. Late outcome from percutaneous tracheostomy using the Portex kit. Chest. 1999;115(4):1070–5.
Streitz Jr JM, Shapshay SM. Airway injury after tracheotomy and endotracheal intubation. Surg Clin North Am. 1991;71(6):1211–30.
Benjamin B, Kertesz T. Obstructive suprastomal granulation tissue following percutaneous tracheostomy. Anaesth Intensive Care. 1999;27(6):596–600.
Koitschev A, Graumueller S, Zenner H-P, Dommerich S, Simon C. Tracheal stenosis and obliteration above the tracheostoma after percutaneous dilational tracheostomy. Crit Care Med. 2003;31(5):1574–6.
Noppen M, Schlesser M, Meysman M, D’Haese J, Peche R, Vincken W. Bronchoscopic balloon dilatation in the combined management of postintubation stenosis of the trachea in adults. Chest. 1997;112(4):1136–40.
Courcy PA, Rodriguez A, Garrett HE. Operative technique for repair of tracheoinnominate artery fistula. J Vasc Surg. 1985;2(2):332–4.
Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth. 2006;96(1):127–31.
Brewster DC, Moncure AC, Darling RC, Ambrosino JJ, Abbott WM. Innominate artery lesions: problems encountered and lessons learned. J Vasc Surg. 1985;2(1):99–112.
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Baker, T., Skelton, S., Turner, K., Aijazi, H. (2013). Obtaining a Surgical Airway. In: Moore, L., Turner, K., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6123-4_13
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