Zusammenfassung
Die Atemwegssicherung stellt eine zentrale Maßnahme in der Notfall- und Intensivmedizin dar, um jederzeit eine ausreichende Oxygenierung zu gewährleisten. Aufgrund des meist kritischen Patientenzustandes, der oft eingeschränkten Umgebungsbedingungen und oft auch unzureichender Erfahrung aller Beteiligten ist sie sehr risikobehaftet. Oberstes Ziel ist deshalb die Umgehung einer Intubation durch konsequente Anwendung nichtinvasiver Beatmung gerade auch im präklinischen Bereich. Bei bestehender Notwendigkeit zur Intubation müssen ausreichende Rückfallebenen bzw. Alternativkonzepte zur Beherrschung des möglicherweise schwierigen Atemweges vorhanden sein. Als moderne, unterstützende Verfahren stehen hier die fiberoptische Wachintubation und Videolaryngoskope zur Verfügung, mit denen die Sicherheit und Erfolgsrate deutlich verbessert werden können. Aufgrund der ubiquitären Anwendbarkeit erscheint der Routineeinsatz der Videolaryngoskopie in der Notfall- und Intensivmedizin empfehlenswert.
Abstract
A secured airway is of utmost importance in emergency and intensive care medicine to ensure sufficient oxygenation. In emergency and intensive care medicine, patients are usually considered to be in a life-threatening condition, environmental aspects are far from optimal, and the personal experience of all participants is often limited; thus, any attempt to intubate such patients has to be considered a failure-prone intervention. Therefore, one of the major goals should be the complete avoidance of endotracheal intubation, e.g., via noninvasive ventilation. If intubation is inevitable, it is crucial to plan alternative strategies in case of difficulties or failure. Fiberoptic intubation in alert patients and videolaryngoscopy have proven their effectiveness to decrease the risk of airway difficulties in acute and critically ill patients. Since availability and utility of videolaryngoscopy is not restricted technically, we strongly recommend its use in emergency and intensive care medicine.
Literatur
Asai T, Liu EH, Matsumoto S et al (2009) Use of the Pentax-AWS in 293 patients with difficult airway. Anesthesiology 110:898–904
Asai T (2010) Pentax-AWS videolaryngoscope for awake nasal intubation with unstable necks. Br J Anaesth 104:108–111
Enomoto Y, Asai T, Arai T et al (2008) Pentax-AWS, a new videolaryngoscope is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study. Br J Anaesth 100:544–548
Gunaydin B, Gungor I, Yigit N et al (2007) The Glidescope for tracheal intubation in patients with ankylosing spondylitis. Br J Anaesth 98:408–409
Kim JT, Na HS, Bae JY et al (2008) Glidescope videolaryngoscope: a randomized clinical trail in 203 pediatric patients. Br J Anaesth 101:531–534
Lai HY, Chen IH, Chen A et al (2006) The use of the GlideScope for tracheal intubation for patients with ankylosing spondylitis. Br J Anaesth 97:419–422
Langeron O, Masso E, Huraux C et al (2000) Prediction of difficult mask ventilation. Anesthesiology 92:1229–1236
Lavery GG, McCloskey BV (2008) The difficult airway in adult critical care. Crit Care Med 36:2163–2173
Maharaj C, Buckley E, Harte BH et al (2007) Endotracheal intubation in patients with cervical spine immobilization. Anesthesiology 107:53–59
Maharaj C, Costello J, Higgins BD et al (2007) Retention of tracheal intubation skills by novice personnel: a comparison of Airtraq and Macintosh laryngoscopes. Anaesthesia 62:272–278
Maharaj CH, Costello J, Harte BH et al (2008) Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation. Anaesthesia 63:182–188
Maharaj C, Higgins B, Harte BH et al (2006) Evalution of intubation using the Airtraq or Macintosh laryngoscope by anesthesists in easy and simulated difficult laryngoscopy – a manikin study. Anaesthesia 61:1093–1099
Nava S, Hill N (2009) Non-invasive ventilation in acute respiratory failure. Lancet 374:250–259
Ndoko SK, Amathieu R, Tual L et al (2008) Tracheal intubation of morbidly obese patients: a randomized trail comparing performance of Airtraq and Macintosh laryngoscopes. Br J Anaesth 100:263–268
Nouruzi-Sedeh P, Schumann M, Groeben H (2009) Laryngoscoy via Macintosh blade versus Glidescope: success rate and time for endotracheal intubation in untrained medical personnel. Anesthesiology 110:32–37
Ray DC, Billington C, Kearns PK et al (2009) A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin study. Anaesthesia 64:1207–1210
Savoldelli GH, Schiffer E, Abegg C et al (2008) Comparison of the Glidescope, the McGrath, the Airtraq and the Macintosh laryngoscopes in simulated difficult airways. Anaesthesia 63:1358–1364
Schwartz DE, Matthay MA, Cohen NH (1995) Death or other complications of emergency airway management in criticlly ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 82:367–376
Serocki G, Bein B, Scholz J et al (2009) Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted laryngoscopy and the Glidescope. Eur J Anaesthesiol 27:24–30
Sondhi D, Lippmann M, Murali G (2004) Airway compromise due to angiotensin-converting enzyme inhibitor-induced angioedema. Chest 126:400–404
Suzuki A, Terao M, Aizawa K et al (2009) Pentax-AWS airway scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position. J Anesth 23:162–163
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Kill, C., Kratz, T. Schwieriger Atemweg in der Notfall- und Intensivmedizin. Intensivmed 47, 530–538 (2010). https://doi.org/10.1007/s00390-010-0165-6
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DOI: https://doi.org/10.1007/s00390-010-0165-6